Provider Demographics
NPI:1144298134
Name:RAHMAN, KHAWAJA ATIQ (MD)
Entity type:Individual
Prefix:DR
First Name:KHAWAJA
Middle Name:ATIQ
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 REX HALL LN
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2657
Mailing Address - Country:US
Mailing Address - Phone:813-641-0068
Mailing Address - Fax:813-645-3816
Practice Address - Street 1:6015 REX HALL LN
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2657
Practice Address - Country:US
Practice Address - Phone:813-641-0068
Practice Address - Fax:813-645-3816
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0079013207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10560801OtherCITRUS GROUP UC
FL267227900Medicaid
FL295858OtherAVMED UC
FL200656648OtherTAX ID
FL49283OtherBCBS
FL257406300Medicaid
FL000029271OtherHUMANA UC
FL289370OtherAMERIGROUP UC
FL3535562OtherAETNA UC
FLDB9962OtherRR GROUP
FL00802OtherUNIVERSAL UC
FL10560601OtherCITRUS INDIVIDUAL
FL608813500OtherDEPT OF LABOR
FLB903UOtherBCBS UC
FLME0079013OtherMEDICAL LICENSE
FL285718OtherWELLCARE UC
FLP00152472OtherRR INDIVIDUAL
FL608813500OtherDEPT OF LABOR
FLME0079013OtherMEDICAL LICENSE
FL49283VMedicare ID - Type UnspecifiedMCARE INDIVIDUAL