Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 01068635A | IN |
NPI | 1033163894 |
---|---|
Provider Name | Dr. Ersalan A Rahman |
First Address | South Bend, IN 46617-2808 |
Second Address | South Bend, IN 46617-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 02/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I31354 | (02) | IN |