Provider Demographics
NPI:1376285999
Name:INSTITUTE FOR ADVANCED THORACIC SURGERY
Entity Type:Organization
Organization Name:INSTITUTE FOR ADVANCED THORACIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:GHARAGOZLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-747-1899
Mailing Address - Street 1:5092 ISLEWORTH COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-8920
Mailing Address - Country:US
Mailing Address - Phone:202-841-7304
Mailing Address - Fax:
Practice Address - Street 1:6718 LAKE NONA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7982
Practice Address - Country:US
Practice Address - Phone:407-747-1899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty