Healthcare Provider Details

I. General information

NPI: 1457015646
Provider Name (Legal Business Name): MUHAMMAD ALI REHAN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 W HILLSBORO BLVD
DEERFIELD BEACH FL
33442-1657
US

IV. Provider business mailing address

16550 ROYAL POINCIANA CT
WESTON FL
33326-1743
US

V. Phone/Fax

Practice location:
  • Phone: 954-531-0461
  • Fax:
Mailing address:
  • Phone: 954-544-9687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: