Provider Demographics
NPI:1164579736
Name:RAHIM, FAHIM (MD)
Entity Type:Individual
Prefix:
First Name:FAHIM
Middle Name:
Last Name:RAHIM
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:PO BOX 268934
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8934
Mailing Address - Country:US
Mailing Address - Phone:208-904-4780
Mailing Address - Fax:208-904-4832
Practice Address - Street 1:4511 ZEBE AVE
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-4707
Practice Address - Country:US
Practice Address - Phone:208-904-4780
Practice Address - Fax:208-904-4832
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9261207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807177000Medicaid
ID807177000Medicaid