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General NPI Number Information
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NPI Number | 1508160359
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Entity Type | Organization
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Legal Business Name | AZIZ RAHMAN MD FACP PC
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 1050 MARTIN LUTHER KING DR STE 109
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City | CENTRALIA
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State | IL
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Zip | 62801
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Country | US
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Telephone | 618-532-0998
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Fax | 618-532-0304
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Provider Business Mailing Address
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Address Line | P.O. BOX 1887
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City | CENTRALIA
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State | IL
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Zip | 62801
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Country | US
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Telephone | 618-532-0998
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Fax | 618-532-0304
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | DR. AZIZ U RAHMAN
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Credential | MD, FACP
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Telephone | 618-532-0998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036064167
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License Number State | IL
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