Provider Demographics
NPI:1043215577
Name:SALARI, RAHIM (MD)
Entity Type:Individual
Prefix:
First Name:RAHIM
Middle Name:
Last Name:SALARI
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 1:6563 CRESCENT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-4654
Mailing Address - Country:US
Mailing Address - Phone:863-604-6575
Mailing Address - Fax:
Practice Address - Street 1:6563 CRESCENT LAKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-4654
Practice Address - Country:US
Practice Address - Phone:863-604-6575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30408207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD56581Medicare UPIN
FL038006700Medicaid
FL53553ZMedicare PIN