Healthcare Provider Details

I. General information

NPI: 1306826458
Provider Name (Legal Business Name): REHAN MAHMUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 W. PROFESSIONAL DRIVE
BAY CITY MI
48706-2823
US

IV. Provider business mailing address

401 S. BALLENGER
FLINT MI
48532-3638
US

V. Phone/Fax

Practice location:
  • Phone: 989-894-3278
  • Fax: 989-894-8155
Mailing address:
  • Phone: 810-342-1000
  • Fax: 810-342-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301065063
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: