Provider Demographics
NPI:1073555397
Name:REHEEM, MEDHAT ALLAM (MD)
Entity Type:Individual
Prefix:
First Name:MEDHAT
Middle Name:ALLAM
Last Name:REHEEM
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 1:12900 CORTEZ BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6828
Mailing Address - Country:US
Mailing Address - Phone:352-596-2233
Mailing Address - Fax:352-596-4019
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6828
Practice Address - Country:US
Practice Address - Phone:352-596-2233
Practice Address - Fax:352-596-4019
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376892900Medicaid
FL376892900Medicaid
FL26339XMedicare ID - Type UnspecifiedMEDICARE