Provider Demographics
NPI:1114012044
Name:HASSANZADEH, KAMBIZ (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMBIZ
Middle Name:
Last Name:HASSANZADEH
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 1:801 BRICKELL KEY BLVD
Mailing Address - Street 2:APT 601
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-3711
Mailing Address - Country:US
Mailing Address - Phone:305-270-6001
Mailing Address - Fax:305-270-6955
Practice Address - Street 1:115 SW 36TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-444-2939
Practice Address - Fax:305-444-2966
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 82741174400000X
FLME827412085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01658Medicare PIN
FLG86135Medicare UPIN