=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326093527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE HEALTHCARE P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 01/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 N CLYDE MORRIS BLVD STE A
-----------------------------------------------------
City | DAYTONA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32114-2318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-355-7377
-----------------------------------------------------
Fax | 800-930-4957
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 646 HILLS BLVD
-----------------------------------------------------
City | PORT ORANGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32127-2902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-443-9924
-----------------------------------------------------
Fax | 800-930-4957
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | RIAZ RAHMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 321-443-9924
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME72252
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------