Provider Demographics
NPI:1871607598
Name:RAFIQUE, SYED S (MD)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:S
Last Name:RAFIQUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 HIGHWAY 82 W
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-6538
Mailing Address - Country:US
Mailing Address - Phone:662-453-3167
Mailing Address - Fax:662-453-9180
Practice Address - Street 1:333 HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-6538
Practice Address - Country:US
Practice Address - Phone:662-453-3167
Practice Address - Fax:662-453-9180
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14648174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01276395OtherRAILROAD MEDICARE PTAN
MS00116022Medicaid
MS00116022Medicaid
MSP01276395OtherRAILROAD MEDICARE PTAN