Basic Information
| Provider Information | |||||||||
| NPI: | 1144298134 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAHMAN | ||||||||
| FirstName: | KHAWAJA | ||||||||
| MiddleName: | ATIQ | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6015 REX HALL LN | ||||||||
| Address2: | |||||||||
| City: | APOLLO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335722657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136410068 | ||||||||
| FaxNumber: | 8136453816 | ||||||||
| Practice Location | |||||||||
| Address1: | 6015 REX HALL LN | ||||||||
| Address2: | |||||||||
| City: | APOLLO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335722657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136410068 | ||||||||
| FaxNumber: | 8136453816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 12/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME0079013 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | ME0079013 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10560801 | 01 | FL | CITRUS GROUP UC | OTHER | 267227900 | 05 | FL | MEDICAID | 295858 | 01 | FL | AVMED UC | OTHER | 200656648 | 01 | FL | TAX ID | OTHER | 49283 | 01 | FL | BCBS | OTHER | 257406300 | 05 | FL | MEDICAID | 000029271 | 01 | FL | HUMANA UC | OTHER | 289370 | 01 | FL | AMERIGROUP UC | OTHER | 3535562 | 01 | FL | AETNA UC | OTHER | DB9962 | 01 | FL | RR GROUP | OTHER | 00802 | 01 | FL | UNIVERSAL UC | OTHER | 10560601 | 01 | FL | CITRUS INDIVIDUAL | OTHER | 608813500 | 01 | FL | DEPT OF LABOR | OTHER | B903U | 01 | FL | BCBS UC | OTHER | ME0079013 | 01 | FL | MEDICAL LICENSE | OTHER | 285718 | 01 | FL | WELLCARE UC | OTHER | P00152472 | 01 | FL | RR INDIVIDUAL | OTHER |