MEDICARE: MR. AZIZ U RAHMAN MD

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	207RP1001X	Pulmonary Disease Physician	036064167	IL

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	:	1275540015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AZIZ U RAHMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 955860
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-9126
Country	:	US
Telephone Number	:	636-498-5944
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 M L KING DR
Second Line	:	SUITE 109
City	:	CENTRALIA
State	:	IL
Zip	:	62801-3060
Country	:	US
Telephone Number	:	618-532-0998
Fax Number	:	618-532-0304

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	10/21/2020

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