Provider Demographics
NPI:1598743361
Name:FAIYAZ, RASHID (MD)
Entity Type:Individual
Prefix:
First Name:RASHID
Middle Name:
Last Name:FAIYAZ
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 1:800 HIGHLANDER POINT DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-9465
Mailing Address - Country:US
Mailing Address - Phone:812-542-4921
Mailing Address - Fax:812-949-5966
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:812-944-7701
Practice Address - Fax:812-981-6505
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062019A207RN0300X
OH35078839207RN0300X
KY36526208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00992178OtherRR MEDICARE KY - NICC
IN200315200Medicaid
OH2221241Medicaid
INM400063433OtherMEDICARE - NICC
OHFA4430241Medicare PIN
INM400063433OtherMEDICARE - NICC
IN796270MMMedicare PIN
IN200315200Medicaid