Provider Demographics
NPI:1003867862
Name:RAHM, ROBIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:RAHM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4106 W LAKE MARY BLVD STE 213
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2403
Mailing Address - Country:US
Mailing Address - Phone:407-648-3800
Mailing Address - Fax:407-425-5203
Practice Address - Street 1:4106 W LAKE MARY BLVD STE 213
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2403
Practice Address - Country:US
Practice Address - Phone:407-829-2020
Practice Address - Fax:407-829-2098
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME74066208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104046200Medicaid
FL59-3654810OtherTAX ID
FL59-3654810OtherTAX ID