Provider Demographics
NPI:1538487475
Name:ILYA M RACHMAN MD INC
Entity Type:Organization
Organization Name:ILYA M RACHMAN MD INC
Other - Org Name:RACHMAN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-757-1919
Mailing Address - Street 1:7601 CANBY AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-2974
Mailing Address - Country:US
Mailing Address - Phone:818-757-1919
Mailing Address - Fax:818-757-3134
Practice Address - Street 1:7601 CANBY AVE STE 7
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-2974
Practice Address - Country:US
Practice Address - Phone:818-757-1919
Practice Address - Fax:818-757-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-15
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17349OtherGROUP MEDICARE IDENTIFICATION NUMBER
CAY12508Medicare UPIN