Provider Demographics
NPI:1275768087
Name:ABDUL-KHALEK, RANA (MD)
Entity Type:Individual
Prefix:DR
First Name:RANA
Middle Name:
Last Name:ABDUL-KHALEK
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 1:39 KENT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1698
Mailing Address - Country:US
Mailing Address - Phone:229-391-4130
Mailing Address - Fax:229-391-4138
Practice Address - Street 1:5000 PRAIRIE ROSE DR
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-7792
Practice Address - Country:US
Practice Address - Phone:815-971-2000
Practice Address - Fax:815-971-9070
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072447207V00000X
IL036125328207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275768087Medicaid
IL036125328Medicaid
10193OtherMERCY CARE
1275768087OtherBLUE CROSS BLUE SHIELD
1275768087OtherMOLINA