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NPI Code Detail

MEDICARE: RAHIM KHORASSANIZADEH MD

MEDICARE: RAHIM KHORASSANIZADEH MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207RE0101XEndocrinology, Diabetes & Metabolism PhysicianE-9226AR

General Provider Information

NPI Number : 1790097129
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAHIM KHORASSANIZADEH MD
Provider Business Mailing Address
First Line : 4700 KELLEY HWY
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-5024
Country : US
Telephone Number : 479-709-7460
Fax Number : 479-424-2423
Provider Business Practice Location Address
First Line : 4700 KELLEY HWY
Second Line :
City : FORT SMITH
State : AR
Zip : 72904-5024
Country : US
Telephone Number : 479-709-7460
Fax Number : 479-424-2423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2010
Last Update Date : 01/21/2016

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