Provider Demographics
NPI:1346204070
Name:RAHMAN, MOHAMMAD A (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:A
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3790 CAPITAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-8332
Mailing Address - Country:US
Mailing Address - Phone:269-979-6310
Mailing Address - Fax:269-979-6311
Practice Address - Street 1:2845 CAPITAL AVE SW
Practice Address - Street 2:STE 201
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015
Practice Address - Country:US
Practice Address - Phone:269-979-6310
Practice Address - Fax:269-979-6311
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR41937208600000X
MIMR0419372086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4264301Medicaid
A75071Medicare UPIN