Provider Demographics
NPI:1467512848
Name:RAFATI, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:RAFATI
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 1:3114 W SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1951
Mailing Address - Country:US
Mailing Address - Phone:618-549-8935
Mailing Address - Fax:
Practice Address - Street 1:3114 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1951
Practice Address - Country:US
Practice Address - Phone:618-549-8935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087927207R00000X
CAA-63955207R00000X
AZ35678207R00000X
FLME-94403207R00000X
LA12031-R207R00000X
RIMD-08480207R00000X
MDD-45408207R00000X
HIMD-8672207R00000X
NMMD 2006-0539207R00000X
IL036087927207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64127418Medicaid
IL036087927-4Medicaid
IL036087927-4Medicaid