Provider Demographics
NPI:1609939065
Name:KESHVARI RASTI, HAMID REZA (MD)
Entity Type:Individual
Prefix:
First Name:HAMID
Middle Name:REZA
Last Name:KESHVARI RASTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 347273
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33234-7273
Mailing Address - Country:US
Mailing Address - Phone:305-374-5446
Mailing Address - Fax:954-206-2502
Practice Address - Street 1:260 CRANDON BLVD STE 8
Practice Address - Street 2:
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1537
Practice Address - Country:US
Practice Address - Phone:305-365-1114
Practice Address - Fax:305-365-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 95619207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278583800Medicaid
FL09779OtherBLUE CROSS BLUE SHIELD
FL278583800Medicaid