Provider Demographics
NPI:1437405164
Name:AFSHARIMANI, SEYEDAMIRHOSSEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEYEDAMIRHOSSEIN
Middle Name:
Last Name:AFSHARIMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AMIR
Other - Middle Name:
Other - Last Name:AFSHAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:909 FROSTWOOD DR STE 1.100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2301
Mailing Address - Country:US
Mailing Address - Phone:713-338-6353
Mailing Address - Fax:
Practice Address - Street 1:1635 NORTH LOOP W
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1532
Practice Address - Country:US
Practice Address - Phone:713-867-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1325207R00000X, 208M00000X
MDD79298207R00000X
IL125063297390200000X
MI4301100536390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1437405164Medicaid
MD1437405164Medicaid
IL1437405164Medicaid
IL1437405164Medicare Oscar/Certification
IL1437405164Medicare UPIN
MD1437405164Medicare PIN
IL1437405164Medicare PIN