Provider Demographics
NPI:1639278708
Name:RAHAL, KINAN (MD)
Entity Type:Individual
Prefix:
First Name:KINAN
Middle Name:
Last Name:RAHAL
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 1:3333 CATTLEMEN RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6058
Mailing Address - Country:US
Mailing Address - Phone:941-342-8892
Mailing Address - Fax:941-342-8893
Practice Address - Street 1:3333 CATTLEMEN RD STE 202
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6058
Practice Address - Country:US
Practice Address - Phone:941-342-8892
Practice Address - Fax:941-342-8893
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY49362207R00000X, 207RG0100X
SC36392207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC363920Medicaid
MI70-0-F32947-0OtherBCBS CPIN #
MI4949395-10Medicaid
SC363920Medicaid
SCSC2611A890Medicare PIN
MI70-0-F32947-0OtherBCBS CPIN #