Provider Demographics
NPI:1497902571
Name:RAHMAN, SAIRA MALIK (MD)
Entity Type:Individual
Prefix:
First Name:SAIRA
Middle Name:MALIK
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 1:211 N EDDY ST.
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-3096
Mailing Address - Country:US
Mailing Address - Phone:574-233-7337
Mailing Address - Fax:574-239-1561
Practice Address - Street 1:211 N EDDY ST.
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-3096
Practice Address - Country:US
Practice Address - Phone:574-233-7337
Practice Address - Fax:574-239-1561
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064131A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400060630Medicare PIN