Provider Demographics
NPI:1639350622
Name:SEDAGHEH PAKRAVAN, ALI (MD)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:
Last Name:SEDAGHEH PAKRAVAN
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 1:12953 PALMS WEST DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4990
Mailing Address - Country:US
Mailing Address - Phone:561-795-5130
Mailing Address - Fax:561-795-4160
Practice Address - Street 1:12953 PALMS WEST DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4990
Practice Address - Country:US
Practice Address - Phone:561-795-5130
Practice Address - Fax:561-795-4160
Is Sole Proprietor?:No
Enumeration Date:2007-11-18
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015061207R00000X
FLME113916207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine