Provider Demographics
NPI:1861668824
Name:HATAMIZADEH, PARTA
Entity Type:Individual
Prefix:
First Name:PARTA
Middle Name:
Last Name:HATAMIZADEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100224
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0224
Mailing Address - Country:US
Mailing Address - Phone:352-273-9180
Mailing Address - Fax:352-392-5465
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-5364
Practice Address - Country:US
Practice Address - Phone:352-273-9180
Practice Address - Fax:352-392-5465
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME130286207RN0300X
MI4301100093207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019329000Medicaid
FLIV047ZMedicare PIN