Provider Demographics
NPI:1063460384
Name:RABBANI, RIAZ R (MD)
Entity Type:Individual
Prefix:
First Name:RIAZ
Middle Name:R
Last Name:RABBANI
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 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1096
Mailing Address - Country:US
Mailing Address - Phone:305-585-1111
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1096
Practice Address - Country:US
Practice Address - Phone:305-585-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161073207RC0000X
MO2004010837207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266780CMedicaid
KS200266780EMedicaid
KSKA1021010OtherMEDICARE - CUSHING
KSP00842629OtherRAILROAD MEDICARE
MOP00836130OtherRAILROAD MEDICARE
MO208786400Medicaid
KS200266780FMedicaid
KS200266780AMedicaid
KSKA1021010OtherMEDICARE - CUSHING
MOP00836130OtherRAILROAD MEDICARE
MO208786400Medicaid
KSP00842629OtherRAILROAD MEDICARE
KS200266780FMedicaid