Provider Demographics
NPI:1851645790
Name:RAHEEM MEDICAL CLINIC P C
Entity Type:Organization
Organization Name:RAHEEM MEDICAL CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-878-1300
Mailing Address - Street 1:1501 WABASH STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-4364
Mailing Address - Country:US
Mailing Address - Phone:219-878-1300
Mailing Address - Fax:219-878-9764
Practice Address - Street 1:1501 WABASH STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-4364
Practice Address - Country:US
Practice Address - Phone:219-878-1300
Practice Address - Fax:219-878-9764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty