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General NPI Number Information
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NPI Number | 1679567762
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Entity Type | Individual
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Provider Name | MOHAMAD S RAHBAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 18263 E 10 MILE RD SUITE D
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City | ROSEVILLE
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State | MI
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Zip | 48066-5805
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Country | US
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Telephone | 586-778-4950
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Fax | 586-778-4952
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Provider Business Mailing Address
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Address Line | 19070 E 10 MILE RD
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City | EASTPOINTE
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State | MI
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Zip | 48021-1449
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Country | US
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Telephone | 586-778-4950
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Fax | 586-778-4952
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301076911
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License Number State | MI
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