Basic Information
| Provider Information | |||||||||
| NPI: | 1295782670 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAHMAN | ||||||||
| FirstName: | SALIM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 9434 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658019434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178853888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 S NATIONAL AVE | ||||||||
| Address2: | WEST TOWER, SUITE 700 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178853888 | ||||||||
| FaxNumber: | 4178817638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 08/21/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 112080 | MO | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | C8141 | AR | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 133549001 | 05 | AR | MEDICAID | 2359 | 01 | MO | COX HEALTH PLANS UPI | OTHER | 0200866 | 01 | WA | DEPARTMENT OF LABOR WA | OTHER | 02100024800 | 01 | MO | QUAL CHOICE | OTHER | 18942 | 01 | MO | COX HEALTH PLANS | OTHER | 208708206 | 05 | MO | MEDICAID | 330907 | 01 | MO | HEALTHLINK | OTHER | 4188130001 | 01 | MO | CIGNA MEDICARE | OTHER | 5M328 | 01 | AR | ARKANSAS FIRST SOURCE | OTHER | 5M328 | 01 | AR | HEALTH ADVANTAGE | OTHER | 0602000 | 01 | MO | UNITED HEALTHCARE | OTHER | 107710 | 01 | MO | BLUE CROSS/CHOICE | OTHER | G49864 | 01 | MO | USPS (W/C) | OTHER | 5M328 | 01 | AR | ARKANSAS BC/BS | OTHER | 6749504001 | 01 | MO | CIGNA HEALTHCARE | OTHER |