Provider Demographics
NPI:1104209071
Name:AMIRTABAR, NAVID
Entity Type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:AMIRTABAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:OH
Mailing Address - Zip Code:43025-9497
Mailing Address - Country:US
Mailing Address - Phone:614-446-2843
Mailing Address - Fax:
Practice Address - Street 1:120 SIMEON DR
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:OH
Practice Address - Zip Code:43025-9497
Practice Address - Country:US
Practice Address - Phone:614-446-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH148443164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse