Provider Demographics
NPI:1275540015
Name:RAHMAN, AZIZ U (MD)
Entity Type:Individual
Prefix:MR
First Name:AZIZ
Middle Name:U
Last Name:RAHMAN
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 955860
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-9126
Mailing Address - Country:US
Mailing Address - Phone:636-498-5944
Mailing Address - Fax:
Practice Address - Street 1:1050 M L KING DR
Practice Address - Street 2:SUITE 109
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3060
Practice Address - Country:US
Practice Address - Phone:618-532-0998
Practice Address - Fax:618-532-0304
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064167207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064167Medicaid
IL685550Medicare ID - Type Unspecified
C41711Medicare UPIN