Provider Demographics
NPI:1336123009
Name:SUARA, RAHAMAN OLATUNJI (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHAMAN
Middle Name:OLATUNJI
Last Name:SUARA
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 1:725 CLIFFTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-8323
Mailing Address - Country:US
Mailing Address - Phone:731-658-8900
Mailing Address - Fax:731-658-4079
Practice Address - Street 1:629 NUCKOLLS RD
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1599
Practice Address - Country:US
Practice Address - Phone:731-658-3388
Practice Address - Fax:731-658-4079
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35933208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3870746Medicaid
TN3870745Medicare ID - Type Unspecified
TN3870746Medicaid