Healthcare Provider Details

I. General information

NPI: 1982677068
Provider Name (Legal Business Name): ABDUL RAHMAN KANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 BAYBERRY RD
JACKSONVILLE FL
32256-7432
US

IV. Provider business mailing address

8245 BAYBERRY RD
JACKSONVILLE FL
32256-7432
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-7775
  • Fax: 904-296-7760
Mailing address:
  • Phone: 904-296-7775
  • Fax: 904-296-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME92691
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: