Provider Demographics
NPI:1821251893
Name:ZOLFOGHARY, MIRIAM CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:CHRISTINE
Last Name:ZOLFOGHARY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1206 COUNTRY CLUB BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-2180
Practice Address - Country:US
Practice Address - Phone:239-574-7454
Practice Address - Fax:239-574-9439
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101389208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0007766-00Medicaid
FL4003817OtherCIGNA
FL326854OtherAVMED
FLP1112167OtherFREEDOM
FL166662OtherUNIVERSAL HEALTHCARE
FLP204123OtherOPTIMUM
FL501270OtherWELLCARE
FL9067164OtherAETNA
FLP00940426OtherRAILROAD MCR
FL16251OtherBCBS FL
FLP00940426OtherRAILROAD MCR
FLP1112167OtherFREEDOM