Provider Demographics
NPI:1679503684
Name:RAHMATULLAH, NASIR IQBAL (MD)
Entity Type:Individual
Prefix:MR
First Name:NASIR
Middle Name:IQBAL
Last Name:RAHMATULLAH
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 1:1819 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4077
Mailing Address - Country:US
Mailing Address - Phone:407-870-8220
Mailing Address - Fax:407-900-2163
Practice Address - Street 1:1819 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4077
Practice Address - Country:US
Practice Address - Phone:407-870-8220
Practice Address - Fax:407-900-2163
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376825200Medicaid
FLF53113Medicare UPIN
FL26330Medicare ID - Type Unspecified