Provider Demographics
NPI:1568455269
Name:ASLIE, ARDAVAN M SR (MD)
Entity Type:Individual
Prefix:
First Name:ARDAVAN
Middle Name:M
Last Name:ASLIE
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ARDAVAN
Other - Middle Name:M
Other - Last Name:ASLIE
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1111 EXPOSITION BLVD
Mailing Address - Street 2:BLDG 500B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4314
Mailing Address - Country:US
Mailing Address - Phone:916-920-8811
Mailing Address - Fax:916-920-8817
Practice Address - Street 1:1111 EXPOSITION BLVD
Practice Address - Street 2:BLDG 500B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4314
Practice Address - Country:US
Practice Address - Phone:916-920-8811
Practice Address - Fax:916-920-8817
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2015-10-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CAA60518174400000X
NV14877207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH45168Medicare UPIN
CA00A6015181Medicare PIN
CA00A6015181Medicare PIN