Provider Demographics
NPI:1760595748
Name:RAHIM, K. ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:K.
Middle Name:ANDRE
Last Name:RAHIM
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:PO BOX 636256
Mailing Address - Street 2:CENTRAL CREDENTIALING ML 806
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-245-3107
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-1000
Practice Address - Country:US
Practice Address - Phone:513-584-7355
Practice Address - Fax:513-584-0431
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350650522085R0202X
OH35 0650522085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1506913Medicaid
OH652349OtherAETNA
OH0991075Medicaid
KY64937022Medicaid
WV0217633000Medicaid
IN200039360AMedicaid
OH000000013705OtherANTHEM
OH652349OtherAETNA
OH000000013705OtherANTHEM