Provider Demographics
NPI:1508818451
Name:SEPAHPANAH, FARHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:FARHAD
Middle Name:
Last Name:SEPAHPANAH
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 1:5000 W NATIONAL AVE
Mailing Address - Street 2:VA MEDICAL CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53295-0001
Mailing Address - Country:US
Mailing Address - Phone:414-284-2000
Mailing Address - Fax:414-382-5293
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-284-2000
Practice Address - Fax:414-382-5293
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI469082081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
009906261COtherHUMANA
WI1508818451Medicaid
WI34528300Medicaid
0068Q73601Medicare ID - Type Unspecified
WI1508818451Medicaid