Healthcare Provider Details

I. General information

NPI: 1548536295
Provider Name (Legal Business Name): SHIRAAZ IKRAM RAHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 09/29/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 STATE ST
NEW ALBANY IN
47150-3620
US

IV. Provider business mailing address

519 STATE STREET
NEW ALBANY IN
47150-3620
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-0616
  • Fax: 812-949-3447
Mailing address:
  • Phone: 812-948-0616
  • Fax: 812-949-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number50378
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number50378
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number01078672A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01078672A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: