Provider Demographics
NPI:1083795637
Name:HAGHIGHI FAMILY & SPORTS MEDICINE PA
Entity Type:Organization
Organization Name:HAGHIGHI FAMILY & SPORTS MEDICINE PA
Other - Org Name:HAGHIGHI FAMILY & SPORTS MEDICINE PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGHIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-519-8895
Mailing Address - Street 1:9191 RG SKINNER PRKWY
Mailing Address - Street 2:SUITE 901
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-519-8895
Mailing Address - Fax:
Practice Address - Street 1:9191 RG SKINNER PRKWY
Practice Address - Street 2:SUITE 901
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-519-8895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0004895000Medicaid
FL0004895000Medicaid
FL5832080001Medicare NSC
FLH73999Medicare UPIN