Provider Demographics
NPI:1194833780
Name:BADIOZAMANI, KASRA R (MD)
Entity Type:Individual
Prefix:
First Name:KASRA
Middle Name:R
Last Name:BADIOZAMANI
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 1:2501 N ORANGE AVE STE 182
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4675
Mailing Address - Country:US
Mailing Address - Phone:407-303-2030
Mailing Address - Fax:
Practice Address - Street 1:60 MEMORIAL MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-5980
Practice Address - Country:US
Practice Address - Phone:386-586-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000405132085R0001X
WI1563-3202085R0001X
FLME1543912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6050BHOtherBLUE SHIELD
WA8298531Medicaid
WA0039587OtherLABOR & INDUSTRY
WAMD5014WOtherALASKA MEDICAID
P00818961OtherRAILROAD MEDICARE
WAUS7036111OtherAETNA/USHC SPECIALIST
H23056Medicare UPIN
WAUS7036111OtherAETNA/USHC SPECIALIST