Provider Demographics
NPI:1487669859
Name:ARASHVAND, MOJGAN (DO)
Entity Type:Individual
Prefix:
First Name:MOJGAN
Middle Name:
Last Name:ARASHVAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MOJGAN
Other - Middle Name:
Other - Last Name:ARASHVAND-BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 E STAR CT
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6702
Practice Address - Country:US
Practice Address - Phone:970-252-1020
Practice Address - Fax:970-252-1041
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1618207RC0000X
HIDOS-1128207R00000X
IN02003634B207R00000X
CODR.0072187207RC0000X
CA20A 10170207RC0000X
IL036.122590207RC0000X
ND14311207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI587694-02Medicaid
CO9000227142Medicaid
HI0000262428OtherHMSA BILLING NUMBER
IN201204310Medicaid
INP01283534Medicare PIN
HII60926Medicare UPIN
IN201204310Medicaid