Healthcare Provider Details

I. General information

NPI: 1891971362
Provider Name (Legal Business Name): RASHIDUI ISLAM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 OLD STATE ROAD 64 NE
NEW SALISBURY IN
47161-7726
US

IV. Provider business mailing address

PO BOX 237
NEW SALISBURY IN
47161-0237
US

V. Phone/Fax

Practice location:
  • Phone: 812-347-2491
  • Fax: 812-347-2938
Mailing address:
  • Phone: 812-347-2491
  • Fax: 812-347-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MRS. DANA LEE BROWN
Title or Position: OFFICE NURSE
Credential: L.P.N.
Phone: 812-347-2491