Provider Demographics
NPI:1669498101
Name:KAKAVAND, BAHRAM (MD)
Entity Type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:KAKAVAND
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 1:13535 NEMOURS PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7402
Mailing Address - Country:US
Mailing Address - Phone:407-567-4000
Mailing Address - Fax:407-567-5961
Practice Address - Street 1:13535 NEMOURS PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7402
Practice Address - Country:US
Practice Address - Phone:407-567-4000
Practice Address - Fax:407-567-5961
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1170752080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009650300Medicaid
KY64078389Medicaid
FL009650300Medicaid
0741085Medicare ID - Type Unspecified