Provider Demographics
NPI:1205826732
Name:ALAM, RUKHSANA (MD)
Entity Type:Individual
Prefix:
First Name:RUKHSANA
Middle Name:
Last Name:ALAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11332 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2313
Mailing Address - Country:US
Mailing Address - Phone:513-247-9025
Mailing Address - Fax:513-247-9060
Practice Address - Street 1:11332 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2313
Practice Address - Country:US
Practice Address - Phone:513-247-9025
Practice Address - Fax:513-247-9060
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35051173A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-1180985OtherTAX ID#
OH0586094Medicaid
OH0565562Medicare PIN
OH31-1180985OtherTAX ID#