MEDICARE: DR. RAFIQ U RAHMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	27724	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1048930	OTHER	KY	PASSPORT

General Provider Information

NPI Number	:	1598747099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAFIQ U RAHMAN M.D.

Provider Business Mailing Address
First Line	:	1107 WOODLAND DR
Second Line	:	SUITE 105
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2789
Country	:	US
Telephone Number	:	270-769-6665
Fax Number	:	270-769-0322

Provider Business Practice Location Address
First Line	:	1107 WOODLAND DR
Second Line	:	SUITE 105
City	:	ELIZABETHTOWN
State	:	KY
Zip	:	42701-2789
Country	:	US
Telephone Number	:	270-769-6665
Fax Number	:	270-769-0322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	02/08/2017

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