Provider Demographics
NPI:1710052600
Name:SAHEBZAMANI, AHMAD (MD)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:
Last Name:SAHEBZAMANI
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 1:202 MANATEE AVE EAST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208
Mailing Address - Country:US
Mailing Address - Phone:941-747-8272
Mailing Address - Fax:941-747-4682
Practice Address - Street 1:202 MANATEE AVE EAST
Practice Address - Street 2:GULFCOAST FAMILY PRACTICE
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208
Practice Address - Country:US
Practice Address - Phone:941-747-8272
Practice Address - Fax:941-747-4682
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2380537OtherUNITED HEALTHCARE
5593969OtherFIRST HEALTH
62990OtherBCBS
FLP00213449OtherMEDICARE RAILROAD
04853OtherUNIVERSAL
1424228OtherCIGNA
7231571OtherAETNA OFFICE #50046
62990OtherBCBS
FLE0747BMedicare ID - Type Unspecified
7231571OtherAETNA OFFICE #50046
G70736Medicare UPIN