Healthcare Provider Details

I. General information

NPI: 1952510729
Provider Name (Legal Business Name): RACHID RYAN MACWAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RACHID LAKHDAR M.D

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 E VENICE AVE STE 102
VENICE FL
34285-9083
US

IV. Provider business mailing address

1370 E VENICE AVE STE 102
VENICE FL
34285-9083
US

V. Phone/Fax

Practice location:
  • Phone: 941-412-0026
  • Fax: 941-412-0027
Mailing address:
  • Phone: 941-412-0026
  • Fax: 941-412-0027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME128347
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberP0088
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301086793
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036128441
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: