Individual
RACHELINA PORTOLESE KVIETKUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 237-9340
(574) 239-1474
Mailing address
211 N EDDY ST, SOUTH BEND, IN 46617-3096
(574) 237-9340
(574) 239-1474
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01045522
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000772015
BCBS BMG GOSHEN
IN
05
—
200108300
—
IN
01
—
P01306109
RR MEDICARE
IN
Enumeration date
06/14/2006
Last updated
10/22/2018
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