MEDICARE: RAHEEM MEDICAL CLINIC P C

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1851645790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAHEEM MEDICAL CLINIC P C

Provider Business Mailing Address
First Line	:	1501 WABASH STREET
Second Line	:	SUITE 105
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4364
Country	:	US
Telephone Number	:	219-878-1300
Fax Number	:	219-878-9764

Provider Business Practice Location Address
First Line	:	1501 WABASH STREET
Second Line	:	SUITE 105
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-4364
Country	:	US
Telephone Number	:	219-878-1300
Fax Number	:	219-878-9764

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIRZA RAHEEM
Credential	:	M.D.
Telephone Number	:	219-878-1300

Provider Enumeration Date	:	10/30/2012
Last Update Date	:	10/30/2012

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