Provider Demographics
NPI:1639146624
Name:RAHIMI, RAMIN (DO)
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:RAHIMI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-0838
Mailing Address - Country:US
Mailing Address - Phone:616-447-4090
Mailing Address - Fax:616-447-4098
Practice Address - Street 1:4955 EAST BELTINE
Practice Address - Street 2:SUITE A
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9078
Practice Address - Country:US
Practice Address - Phone:616-447-4090
Practice Address - Fax:616-447-4098
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012094208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114346837Medicaid
MI5410273OtherBCN
MI54102735OtherBCBS
MI114346837Medicaid
0N84390Medicare PIN