Provider Demographics
NPI:1003233834
Name:PANAHI, KAVEH (DPM)
Entity Type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:PANAHI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13760 N 93RD AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4250
Mailing Address - Country:US
Mailing Address - Phone:623-439-2200
Mailing Address - Fax:623-439-7370
Practice Address - Street 1:13760 N 93RD AVE STE 111
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4250
Practice Address - Country:US
Practice Address - Phone:623-439-2200
Practice Address - Fax:623-439-7370
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0793213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ176327Medicare Oscar/Certification