Healthcare Provider Details

I. General information

NPI: 1346204070
Provider Name (Legal Business Name): MOHAMMAD A RAHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 CAPITAL AVE SW STE 201
BATTLE CREEK MI
49015
US

IV. Provider business mailing address

3790 CAPITAL AVE SW
BATTLE CREEK MI
49015-8332
US

V. Phone/Fax

Practice location:
  • Phone: 269-979-6310
  • Fax: 269-979-6311
Mailing address:
  • Phone: 269-979-6310
  • Fax: 269-979-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMR41937
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMR041937
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: