Provider Demographics
NPI:1407877384
Name:VAKILI, BABAK ALEX (MD)
Entity Type:Individual
Prefix:
First Name:BABAK
Middle Name:ALEX
Last Name:VAKILI
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 1:2170 W STATE ROAD 434 STE 190
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4976
Mailing Address - Country:US
Mailing Address - Phone:407-990-1921
Mailing Address - Fax:407-990-1921
Practice Address - Street 1:2170 W STATE ROAD 434 STE 190
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4976
Practice Address - Country:US
Practice Address - Phone:407-990-1921
Practice Address - Fax:407-990-1921
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84848207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269132900Medicaid
FLH74171Medicare UPIN
FL51480ZMedicare PIN