Provider Demographics
NPI:1609891068
Name:LOU, IRAJ GHAHREMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRAJ
Middle Name:GHAHREMAN
Last Name:LOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:832 W CENTRAL BLVD
Mailing Address - Street 2:IMMUNOLOGY CLINIC
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-1809
Mailing Address - Country:US
Mailing Address - Phone:407-836-2690
Mailing Address - Fax:407-836-2538
Practice Address - Street 1:832 W CENTRAL BLVD
Practice Address - Street 2:IMMUNOLOGY CLINIC
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-1809
Practice Address - Country:US
Practice Address - Phone:407-836-2690
Practice Address - Fax:407-836-2538
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0049252207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045772801Medicaid
FLD 21215Medicare UPIN
FL045772801Medicaid
FL07417SMedicare PIN