Provider Demographics
NPI:1417968827
Name:REHMAN, NINA HABIB (DO)
Entity type:Individual
Prefix:DR
First Name:NINA
Middle Name:HABIB
Last Name:REHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15520 19 MILE RD STE 480
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6332
Mailing Address - Country:US
Mailing Address - Phone:586-228-1010
Mailing Address - Fax:586-228-8570
Practice Address - Street 1:15520 19 MILE RD STE 480
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038
Practice Address - Country:US
Practice Address - Phone:586-228-1010
Practice Address - Fax:586-228-8570
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H26353Medicare UPIN
MIM77020024Medicare ID - Type Unspecified
MI486493011Medicaid
ON58160Medicare ID - Type Unspecified
MIP00302319OtherRR MEDICARE