Provider Demographics
NPI:1508160359
Name:AZIZ RAHMAN MD FACP PC
Entity Type:Organization
Organization Name:AZIZ RAHMAN MD FACP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:U
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:618-532-0998
Mailing Address - Street 1:P.O. BOX 1887
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801
Mailing Address - Country:US
Mailing Address - Phone:618-532-0998
Mailing Address - Fax:618-532-0304
Practice Address - Street 1:1050 MARTIN LUTHER KING DR
Practice Address - Street 2:STE 109
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801
Practice Address - Country:US
Practice Address - Phone:618-532-0998
Practice Address - Fax:618-532-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064167207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036064167Medicaid
IL685550Medicare PIN
ILC41711Medicare UPIN