Provider Demographics
NPI:1437145455
Name:SEPEHRI, BAHRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHRAM
Middle Name:
Last Name:SEPEHRI
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 1:1425 STATE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4909
Mailing Address - Country:US
Mailing Address - Phone:812-945-2229
Mailing Address - Fax:812-949-2229
Practice Address - Street 1:230 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2026
Practice Address - Country:US
Practice Address - Phone:502-629-8990
Practice Address - Fax:502-394-3604
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030087A208000000X
KY20885208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64208853Medicaid
IN100115780AMedicaid
IN351708493OtherTAX ID#