Healthcare Provider Details

I. General information

NPI: 1366772717
Provider Name (Legal Business Name): KAUSAR RAHMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 KERCHEVAL ST
DETROIT MI
48214-2439
US

IV. Provider business mailing address

1141 FOXBORO
TROY MI
48083-5460
US

V. Phone/Fax

Practice location:
  • Phone: 313-921-5500
  • Fax:
Mailing address:
  • Phone: 248-212-1724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901019933
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: