Healthcare Provider Details

I. General information

NPI: 1033299078
Provider Name (Legal Business Name): FARROKH RAHNEMOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 MIGALDI LN SUITE 300
LANSING MI
48917-7750
US

IV. Provider business mailing address

2111 MERRITT RD STE 202
EAST LANSING MI
48823-6916
US

V. Phone/Fax

Practice location:
  • Phone: 517-627-6024
  • Fax: 517-627-9339
Mailing address:
  • Phone: 517-627-6024
  • Fax: 517-627-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301037074
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: