Provider Demographics
NPI:1336107507
Name:RAHIMIZADEH, HOOTAN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOOTAN
Middle Name:
Last Name:RAHIMIZADEH
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 1:16980 DALLAS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1908
Mailing Address - Country:US
Mailing Address - Phone:972-699-3508
Mailing Address - Fax:844-292-1459
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-699-3508
Practice Address - Fax:844-292-1459
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3792207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152650101Medicaid
TX8864B1Medicare ID - Type Unspecified
TX152650101Medicaid