Provider Demographics
NPI:1831129006
Name:ARJOMAND-FARD, HEIDAR (MD)
Entity Type:Individual
Prefix:
First Name:HEIDAR
Middle Name:
Last Name:ARJOMAND-FARD
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 1:21097 NE 27TH CT
Mailing Address - Street 2:STE 480
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1204
Mailing Address - Country:US
Mailing Address - Phone:786-428-1059
Mailing Address - Fax:786-428-1062
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:STE 480
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:786-428-1059
Practice Address - Fax:786-428-1062
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016525207RC0000X
NH12331207RC0000X
FLME110426207RC0000X
CAC55809207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME409970099Medicaid
NH30204413Medicaid
NHSX2683Medicare PIN
ME409970099Medicaid
MECA1374Medicare PIN