Provider Demographics
NPI:1902365141
Name:HOSSEINIAN, NIMA MOHAMADALI (MD)
Entity Type:Individual
Prefix:
First Name:NIMA
Middle Name:MOHAMADALI
Last Name:HOSSEINIAN
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 1:1740 MANAROLA ST APT E-403
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-0622
Mailing Address - Country:US
Mailing Address - Phone:321-750-6467
Mailing Address - Fax:
Practice Address - Street 1:806 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-6625
Practice Address - Country:US
Practice Address - Phone:407-483-3376
Practice Address - Fax:407-201-7304
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME156275207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine