Provider Demographics
NPI:1508865239
Name:RAHMAN, KHAWAJA YASSIR (MD)
Entity type:Individual
Prefix:
First Name:KHAWAJA
Middle Name:YASSIR
Last Name:RAHMAN
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 1:101 E MILLER RD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:IL
Mailing Address - Zip Code:61081-1252
Mailing Address - Country:US
Mailing Address - Phone:815-625-4790
Mailing Address - Fax:
Practice Address - Street 1:1505 EASTLAND DR STE 320
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-7912
Practice Address - Country:US
Practice Address - Phone:309-661-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29321207RC0200X
AZ70066207RC0200X
CT75961207RC0200X
IN01090406A207RC0200X
NC2004-01666207R00000X
IL036134633207R00000X, 207RP1001X
MO2024010352207RC0200X
FLME133591207RC0200X
MS33242207RC0200X
NJ25MA10410200207RC0200X
TN59968207RC0200X
TXU8492207RC0200X
PAMD486985207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1508865239Medicaid
NC5900244Medicaid
FL023422900Medicaid
TNQ057290Medicaid
NC1382MOtherBCBS OF NC
AZ131861Medicaid
NC2037778CMedicare ID - Type UnspecifiedLUMBERTON HEALTH CENTER