Provider Demographics
NPI:1407924954
Name:RAFIQ, REHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:REHAN
Middle Name:
Last Name:RAFIQ
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 1:11155 DUNN RD STE 309E
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6111
Mailing Address - Country:US
Mailing Address - Phone:314-953-8799
Mailing Address - Fax:
Practice Address - Street 1:11155 DUNN RD STE 309E
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6111
Practice Address - Country:US
Practice Address - Phone:314-953-8799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234248207P00000X
IL036124859207RG0100X
MO2008002909207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02638099Medicaid
MO14079249Medicaid
MO14079249Medicaid
NM1164Q1Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NYI26079Medicare UPIN