MEDICARE: DR. IMTIAZ RASUL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME-112178	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205071719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMTIAZ RASUL M.D.

Provider Business Mailing Address
First Line	:	10175 FORTUNE PKWY UNIT 206
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6748
Country	:	US
Telephone Number	:	904-379-8748
Fax Number	:	904-379-8796

Provider Business Practice Location Address
First Line	:	10175 FORTUNE PKWY
Second Line	:	SUITE 206
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6746
Country	:	US
Telephone Number	:	904-379-8748
Fax Number	:	904-379-8796

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	10/10/2025

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