Provider Demographics
NPI:1063448678
Name:BEHZADPOUR, FARIBA (MD)
Entity Type:Individual
Prefix:DR
First Name:FARIBA
Middle Name:
Last Name:BEHZADPOUR
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 1:4722 W KELLOGG DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-2508
Mailing Address - Country:US
Mailing Address - Phone:316-440-2565
Mailing Address - Fax:316-440-2750
Practice Address - Street 1:3701 E 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-2086
Practice Address - Country:US
Practice Address - Phone:316-866-2000
Practice Address - Fax:316-866-2084
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-26762207Q00000X
TXM3470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G66710Medicare UPIN
KS11960OtherPHS
KS053292Medicare ID - Type Unspecified
KS100266OtherHPK
KS12084269OtherMULTIPLAN
G66710Medicare UPIN
KS053292OtherBCBS
KS25578OtherCOVENTRY