Provider Demographics
NPI:1689677726
Name:RAABE, JOHN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:RAABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 CHATFIELD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3702
Mailing Address - Country:US
Mailing Address - Phone:614-486-8035
Mailing Address - Fax:614-486-8068
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016482207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO142772OtherGROUP HEALTH PLAN
MO177043OtherBC/BS OF MISSOURI
MOA77676OtherMERCY HEALTH PLAN
MO504739707Medicaid
060069698OtherRAILROAD MEDICARE
IL07932005OtherBC/BS OF ILLINOIS
MO517213OtherHEALTHLINK
MO2501669OtherUNITED HEALTHCARE
MOA77676Medicare UPIN
565050148Medicare PIN
060069698OtherRAILROAD MEDICARE
MO000013563Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
P00401194Medicare PIN
MO517213OtherHEALTHLINK
IL203859Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER