Provider Demographics
NPI:1124271010
Name:FADERANI, M RAHAT (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:M RAHAT
Middle Name:
Last Name:FADERANI
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5913 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1303
Mailing Address - Country:US
Mailing Address - Phone:561-543-8888
Mailing Address - Fax:888-663-8123
Practice Address - Street 1:5913 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1303
Practice Address - Country:US
Practice Address - Phone:561-965-4300
Practice Address - Fax:561-965-4399
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10474208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice