Provider Demographics
NPI:1710975099
Name:IRVIN RAHAIM, KIERA M (MD)
Entity Type:Individual
Prefix:DR
First Name:KIERA
Middle Name:M
Last Name:IRVIN RAHAIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:4321 N MACDILL AVE STE 305
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6390
Practice Address - Country:US
Practice Address - Phone:813-961-7440
Practice Address - Fax:813-962-0951
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0087126207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267840300Medicaid
FL79216ZMedicare ID - Type Unspecified
FLH99620Medicare UPIN