Provider Demographics
NPI:1033299078
Name:RAHNEMOON, FARROKH (MD)
Entity Type:Individual
Prefix:
First Name:FARROKH
Middle Name:
Last Name:RAHNEMOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 MERRITT RD
Mailing Address - Street 2:STE 202
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6916
Mailing Address - Country:US
Mailing Address - Phone:517-627-6024
Mailing Address - Fax:517-627-9339
Practice Address - Street 1:644 MIGALDI LN
Practice Address - Street 2:SUITE 300
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7750
Practice Address - Country:US
Practice Address - Phone:517-627-6024
Practice Address - Fax:517-627-9339
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037074208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104730919Medicaid
MI3502310142OtherBCBS OF MICHIGAN
MIP14790001Medicare ID - Type Unspecified
MIB46654Medicare UPIN