Provider Demographics
NPI:1215188925
Name:KESHAVARZI, REZA (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:KESHAVARZI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SW 62ND PL STE 210
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4825
Mailing Address - Country:US
Mailing Address - Phone:786-801-3883
Mailing Address - Fax:305-851-0419
Practice Address - Street 1:7330 SW 62ND PL STE 210
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4825
Practice Address - Country:US
Practice Address - Phone:786-801-3883
Practice Address - Fax:305-851-0419
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110684208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery