Healthcare Provider Details

I. General information

NPI: 1659259893
Provider Name (Legal Business Name): AMIR RAHMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 CARPENTER ST STE 5
DETROIT MI
48212-2784
US

IV. Provider business mailing address

3611 CARPENTER ST STE 5
DETROIT MI
48212-2784
US

V. Phone/Fax

Practice location:
  • Phone: 313-733-8286
  • Fax:
Mailing address:
  • Phone: 313-733-8286
  • Fax: 313-826-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014036
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: