Provider Demographics
NPI:1356542112
Name:RAHIM, MALIK TARIQ (MD)
Entity type:Individual
Prefix:DR
First Name:MALIK
Middle Name:TARIQ
Last Name:RAHIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10170 W TROPICANA AVE # 156-336
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8465
Mailing Address - Country:US
Mailing Address - Phone:702-659-7822
Mailing Address - Fax:702-659-7805
Practice Address - Street 1:2755 SILVER CREEK RD
Practice Address - Street 2:SUITE 217
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7904
Practice Address - Country:US
Practice Address - Phone:928-704-6070
Practice Address - Fax:928-704-4736
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2020-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14371207RC0000X, 207RI0011X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1356542112Medicaid
NVV111726Medicare PIN
NVGH125ZMedicare PIN