Provider Demographics
NPI:1073712071
Name:ESMAEILI, EHSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:EHSAN
Middle Name:
Last Name:ESMAEILI
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 1:1905 CLINT MOORE RD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496
Mailing Address - Country:US
Mailing Address - Phone:561-241-4758
Mailing Address - Fax:561-998-4246
Practice Address - Street 1:1905 CLINT MOORE RD.
Practice Address - Street 2:SUITE 105
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33496
Practice Address - Country:US
Practice Address - Phone:561-241-4758
Practice Address - Fax:561-998-4246
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1153262086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand