Provider Demographics
NPI:1689200701
Name:KADIVAR, SOHRAB CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:SOHRAB
Middle Name:CHRISTOPHER
Last Name:KADIVAR
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 1:3000 ARLINGTON AVENUE
Mailing Address - Street 2:RUPPERT HEALTH CENTER, ROOM 0012
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-3685
Mailing Address - Fax:419-383-6244
Practice Address - Street 1:3000 ARLINGTON AVENUE
Practice Address - Street 2:RUPPERT HEALTH CENTER, ROOM 0012
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-2595
Practice Address - Country:US
Practice Address - Phone:419-383-3685
Practice Address - Fax:419-383-6244
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program