Provider Demographics
NPI:1619937265
Name:BOUKHEMIS, RABAH (MD)
Entity Type:Individual
Prefix:
First Name:RABAH
Middle Name:
Last Name:BOUKHEMIS
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 1:1600 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3656
Mailing Address - Country:US
Mailing Address - Phone:304-691-1100
Mailing Address - Fax:304-691-1183
Practice Address - Street 1:1600 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 1500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3656
Practice Address - Country:US
Practice Address - Phone:304-691-1100
Practice Address - Fax:304-736-5768
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV16136208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0802206Medicaid
WV0042878000Medicaid
KY64697998Medicaid
WV0676612Medicare ID - Type Unspecified
KY64697998Medicaid