Kevin M Rak, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

36007 Issued in WI

Practice address

2817 New Pinery Rd
Portage, WI 53901-9257

Phone

(608) 742-4131

Fax

(608) 826-2710

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Portage Radiology, SC

  • Diagnostic Radiology Physician
  • Portage, WI
  • NPI 1104834811

  Diagnostic Radiology

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285643957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019257",
            "telephone_number": "608-742-4131",
            "fax_number": "608-826-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2817 NEW PINERY RD",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539019257",
            "telephone_number": "608-742-4131",
            "fax_number": "608-826-2710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAK",
        "first_name": "KEVIN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "36007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32117500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Portcare Home LLC
• Andrew Taylor Putney, MD
• Richard J Qualy, MD
• Susan I Quiriconi, MSW CICSW
• Matthew Gregory Rajala, PA
• Tomi Randall
• Kristin Ranum, LCSW
• Bryan Rastello
• Marjorie Rau
• Brittany Leigh Read, CCC-SLP

• All providers in Portage, WI
• Diagnostic Radiology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.