Provider Demographics
NPI:1942283288
Name:BEHFOROUZ, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:BEHFOROUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3985 W 106TH ST
Mailing Address - Street 2:STE 120
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7778
Mailing Address - Country:US
Mailing Address - Phone:317-334-4424
Mailing Address - Fax:317-334-4425
Practice Address - Street 1:3985 W 106TH ST
Practice Address - Street 2:STE 120
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7778
Practice Address - Country:US
Practice Address - Phone:317-334-4424
Practice Address - Fax:317-334-4425
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01046877207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00040763OtherRAILROAD RETIREMENT
000000290437OtherANTHEM
IN7590106OtherAETNA
000000290437OtherANTHEM
P00040763OtherRAILROAD RETIREMENT