Provider Demographics
NPI:1093818262
Name:SAREH, HOUTAN (MD)
Entity Type:Individual
Prefix:
First Name:HOUTAN
Middle Name:
Last Name:SAREH
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-985-1925
Mailing Address - Fax:239-468-7929
Practice Address - Street 1:16271 BASS RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3616
Practice Address - Country:US
Practice Address - Phone:239-985-1929
Practice Address - Fax:239-468-7929
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95768207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304134OtherAVMED
FL7944871OtherAETNA
FL9338156OtherCIGNA
FL57601OtherBCBS OF FL
FLP954381OtherOPTIMUM
FL276252800Medicaid
FLP01319830OtherRR MEDICARE
FLP100579OtherFRREDOM
FL9338156OtherCIGNA
FLI68750Medicare UPIN
FLAA837WMedicare PIN