Provider Demographics
NPI:1346212693
Name:RAHMAN, AZIZUR (MD)
Entity Type:Individual
Prefix:
First Name:AZIZUR
Middle Name:
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 1:3865 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5603
Mailing Address - Country:US
Mailing Address - Phone:815-399-2190
Mailing Address - Fax:815-399-5543
Practice Address - Street 1:695 N PERRYVILLE RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6225
Practice Address - Country:US
Practice Address - Phone:815-904-6011
Practice Address - Fax:815-399-5543
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILO36129423207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621298175OtherDEFAULT
TN4134410OtherTENNCARE SELECT
TN4134410OtherBLUE CROSS ADVANTAGE
ILP01320105OtherRAILROAD MEDICARE
TN371909283OtherTRICARE
TN3843144Medicaid
TN4134410OtherBLUE CROSS BLUE SHIELD
TN371909283OtherTRICARE
TNG35448Medicare UPIN
IL214298002Medicare PIN