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General NPI Number Information
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NPI Number | 1124271010
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Entity Type | Individual
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Provider Name | M RAHAT FADERANI D.O., M.P.H.
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Gender | Male
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 5913 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1303
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Country | US
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Telephone | 561-965-4300
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Fax | 561-965-4399
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Provider Business Mailing Address
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Address Line | 5913 S CONGRESS AVE
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City | ATLANTIS
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State | FL
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Zip | 33462-1303
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Country | US
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Telephone | 561-543-8888
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Fax | 888-663-8123
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS10474
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License Number State | FL
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