Provider Demographics
NPI:1659623221
Name:KHOSRAVANI, KATAYOUN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATAYOUN
Middle Name:
Last Name:KHOSRAVANI
Suffix:
Gender:F
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:PO BOX 1239
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48099-1239
Mailing Address - Country:US
Mailing Address - Phone:248-824-6600
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:7447 CENTRAL BUSINESS PARK DR
Practice Address - Street 2:SUITE 104
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2831
Practice Address - Country:US
Practice Address - Phone:757-853-1380
Practice Address - Fax:855-252-4450
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012490552083P0901X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine