1144298134 NPI number — DR. KHAWAJA ATIQ RAHMAN MD

Table of content: (NPI 1952541625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144298134 NPI number — DR. KHAWAJA ATIQ RAHMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHMAN
Provider First Name:
KHAWAJA
Provider Middle Name:
ATIQ
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144298134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6015 REX HALL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APOLLO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33572-2657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-641-0068
Provider Business Mailing Address Fax Number:
813-645-3816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6015 REX HALL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APOLLO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33572-2657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-641-0068
Provider Business Practice Location Address Fax Number:
813-645-3816
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME0079013 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0200X , with the licence number: ME0079013 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10560801 . This is a "CITRUS GROUP UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 267227900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 295858 . This is a "AVMED UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200656648 . This is a "TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 49283 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 257406300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000029271 . This is a "HUMANA UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 289370 . This is a "AMERIGROUP UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 3535562 . This is a "AETNA UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DB9962 . This is a "RR GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00802 . This is a "UNIVERSAL UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10560601 . This is a "CITRUS INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 608813500 . This is a "DEPT OF LABOR" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: B903U . This is a "BCBS UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME0079013 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 285718 . This is a "WELLCARE UC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: P00152472 . This is a "RR INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 005795000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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