Provider Demographics
NPI:1164585766
Name:DEHGHANPISHEH, KEIVAN (PH D , MD)
Entity Type:Individual
Prefix:DR
First Name:KEIVAN
Middle Name:
Last Name:DEHGHANPISHEH
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Gender:M
Credentials:PH D , MD
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Mailing Address - Street 1:12955 PALMS WEST DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9217
Mailing Address - Country:US
Mailing Address - Phone:561-899-0762
Mailing Address - Fax:833-217-6176
Practice Address - Street 1:12955 PALMS WEST DR STE 203
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9217
Practice Address - Country:US
Practice Address - Phone:561-899-0762
Practice Address - Fax:833-217-6176
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2023-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME92999207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI39729Medicare UPIN