Healthcare Provider Details

I. General information

NPI: 1346212693
Provider Name (Legal Business Name): AZIZUR RAHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 N PERRYVILLE RD
ROCKFORD IL
61107-6225
US

IV. Provider business mailing address

695 N PERRYVILLE RD STE 3
ROCKFORD IL
61107-6225
US

V. Phone/Fax

Practice location:
  • Phone: 815-904-6011
  • Fax: 815-904-6171
Mailing address:
  • Phone: 815-904-6011
  • Fax: 815-904-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberO36129423
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: