Provider Demographics
NPI:1811097462
Name:RAHIM, FAZAL (MD)
Entity type:Individual
Prefix:
First Name:FAZAL
Middle Name:
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 1:200 BATTLE ST E
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2420
Mailing Address - Country:US
Mailing Address - Phone:256-362-9677
Mailing Address - Fax:256-362-9676
Practice Address - Street 1:200 BATTLE ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2420
Practice Address - Country:US
Practice Address - Phone:256-362-9677
Practice Address - Fax:256-362-9676
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL255712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009960855Medicaid
I01478Medicare UPIN
AL0515222290Medicare ID - Type Unspecified