Provider Demographics
NPI:1811391097
Name:KAGHAZCHI, KASRA (DPM)
Entity Type:Individual
Prefix:DR
First Name:KASRA
Middle Name:
Last Name:KAGHAZCHI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 NW 168TH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6051
Mailing Address - Country:US
Mailing Address - Phone:786-657-2757
Mailing Address - Fax:786-657-2758
Practice Address - Street 1:150 NW 168TH ST STE 303
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6051
Practice Address - Country:US
Practice Address - Phone:786-657-2757
Practice Address - Fax:786-657-2758
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-16
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3670213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3670OtherFL MEDICAL LICENSE