Healthcare Provider Details

I. General information

NPI: 1811612773
Provider Name (Legal Business Name): AZIM RATTANSI CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4702 CREEKSTONE DR
DURHAM NC
27703-8410
US

IV. Provider business mailing address

4702 CREEKSTONE DR
DURHAM NC
27703-8410
US

V. Phone/Fax

Practice location:
  • Phone: 919-797-1230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: