Provider Demographics
NPI:1427088442
Name:RAHMATULLAH, MEHR TAJ (MD)
Entity type:Individual
Prefix:MRS
First Name:MEHR
Middle Name:TAJ
Last Name:RAHMATULLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4077
Mailing Address - Country:US
Mailing Address - Phone:407-870-8220
Mailing Address - Fax:407-870-8990
Practice Address - Street 1:1819 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4077
Practice Address - Country:US
Practice Address - Phone:407-870-8220
Practice Address - Fax:407-870-8990
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376285200Medicaid
FLG56394Medicare UPIN
FL32586Medicare ID - Type Unspecified