=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225519333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MED MANAGEMENT INDIANA PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2018
-----------------------------------------------------
Last Update Date | 10/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 MARYMOUNT VILLAGE DR
-----------------------------------------------------
City | GARFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-2974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-365-6271
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7272 WURZBACH RD STE 601
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-4803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-615-3483
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR & SHAREHOLDER
-----------------------------------------------------
Name | DR. RIAZ RAHMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 321-443-9924
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------