Provider Demographics
NPI:1316996077
Name:RASHIDI, DAUD
Entity type:Individual
Prefix:MR
First Name:DAUD
Middle Name:
Last Name:RASHIDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 45TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3289
Mailing Address - Country:US
Mailing Address - Phone:219-922-6911
Mailing Address - Fax:219-922-6968
Practice Address - Street 1:3100 45TH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3289
Practice Address - Country:US
Practice Address - Phone:219-922-6911
Practice Address - Fax:219-922-6968
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1000521A363AS0400X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN409340LMedicare ID - Type Unspecified