Provider Demographics
NPI:1619059995
Name:BEHNAM BIRGANI DO PA
Entity Type:Organization
Organization Name:BEHNAM BIRGANI DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRGANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-491-4888
Mailing Address - Street 1:4611 S UNIVERSITY DR
Mailing Address - Street 2:DAVIE, FL 33328
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-491-4888
Mailing Address - Fax:
Practice Address - Street 1:4602 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5206
Practice Address - Country:US
Practice Address - Phone:954-491-4888
Practice Address - Fax:954-202-0504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007073207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252376100Medicaid
FL57393OtherBCBS
FL380001376OtherRAILROAD MEDICARE
FL8468488OtherCIGNA
FL252376100Medicaid
FLK3942Medicare PIN