MEDICARE: MR. RASSOUL ABTAHI

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	174400000X	Specialist	PT0004946	FL

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

General Provider Information

NPI Number	:	1891966438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RASSOUL ABTAHI

Provider Business Mailing Address
First Line	:	4999 W 8TH AVE
Second Line	:	#6
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-821-0100
Fax Number	:	305-821-0808

Provider Business Practice Location Address
First Line	:	4999 W 8TH AVE
Second Line	:	#6
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-821-0100
Fax Number	:	305-821-0808

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

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	03/21/2008

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Directions to “ MR. RASSOUL ABTAHI ” Practice Location

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