Provider Demographics
NPI:1376757054
Name:RAHMAN, RUKHSANA IKRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:RUKHSANA
Middle Name:IKRAM
Last Name:RAHMAN
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 1:630 EASTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129
Mailing Address - Country:US
Mailing Address - Phone:812-280-0796
Mailing Address - Fax:812-280-0796
Practice Address - Street 1:630 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129
Practice Address - Country:US
Practice Address - Phone:812-280-0796
Practice Address - Fax:812-280-0796
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E78142Medicare UPIN
IN124940Medicare ID - Type Unspecified