Provider Demographics
NPI:1982677068
Name:KANI, ABDUL RAHMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:RAHMAN
Last Name:KANI
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 1:8245 BAYBERRY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7432
Mailing Address - Country:US
Mailing Address - Phone:904-296-7775
Mailing Address - Fax:904-296-7760
Practice Address - Street 1:8245 BAYBERRY RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7432
Practice Address - Country:US
Practice Address - Phone:904-296-7775
Practice Address - Fax:904-296-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92691207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00471928OtherRAILROAD MEDICARE
FL272011600Medicaid
FL01892XMedicare PIN
FL272011600Medicaid