Provider Demographics
NPI:1215224860
Name:FAHIM, RATHI
Entity Type:Individual
Prefix:MRS
First Name:RATHI
Middle Name:
Last Name:FAHIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12412 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3255
Mailing Address - Country:US
Mailing Address - Phone:210-757-7000
Mailing Address - Fax:
Practice Address - Street 1:12412 JUDSON RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3255
Practice Address - Country:US
Practice Address - Phone:210-757-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9701207P00000X
MI4301098661207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine