Provider Demographics
NPI:1962627893
Name:PERWAIZ RAHIM MD PA
Entity type:Organization
Organization Name:PERWAIZ RAHIM MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERWAIZ
Authorized Official - Middle Name:HUSSAIN
Authorized Official - Last Name:RAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-534-3707
Mailing Address - Street 1:4712 EXPLORATION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-3319
Mailing Address - Country:US
Mailing Address - Phone:863-534-3707
Mailing Address - Fax:863-534-3697
Practice Address - Street 1:4712 EXPLORATION AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-3319
Practice Address - Country:US
Practice Address - Phone:863-534-3707
Practice Address - Fax:863-534-3697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82736174400000X
207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261855900Medicaid
FL01797YMedicare ID - Type Unspecified