Provider Demographics
NPI:1639951338
Name:MADINA HOUSE CLINIC INC
Entity Type:Organization
Organization Name:MADINA HOUSE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMER
Authorized Official - Middle Name:SYED
Authorized Official - Last Name:RAHEEMULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-902-7080
Mailing Address - Street 1:43575 MISSION BLVD # 1019
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-5831
Mailing Address - Country:US
Mailing Address - Phone:510-902-7080
Mailing Address - Fax:
Practice Address - Street 1:43575 MISSION BLVD # 1019
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-5831
Practice Address - Country:US
Practice Address - Phone:510-902-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-17
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty