Provider Demographics
NPI:1730459769
Name:FORT LAUDERDALE PSYCHIATRISTS LLC
Entity Type:Organization
Organization Name:FORT LAUDERDALE PSYCHIATRISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAIDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRMESDAGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-383-3200
Mailing Address - Street 1:22 PRESTIGE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-3441
Mailing Address - Country:US
Mailing Address - Phone:214-383-3200
Mailing Address - Fax:214-383-3211
Practice Address - Street 1:915 MIDDLE RIVER DR
Practice Address - Street 2:SUITE 317
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3544
Practice Address - Country:US
Practice Address - Phone:214-383-3200
Practice Address - Fax:214-383-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty