Individual
PAUL J. RAIMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11141 PARKVIEW PLAZA DR, SUITE 310, FORT WAYNE, IN 46845-1701
(260) 489-8898
(260) 373-4695
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
01034793A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000595629
ANTHEM
IN
01
—
000000614766
ANTHEM
IN
01
—
020037713
RR MEDICARE
IN
05
—
0610888
—
OH
05
—
100096150
—
IN
05
—
100096150A
—
IN
Enumeration date
08/16/2005
Last updated
03/23/2013
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