Provider Demographics
NPI:1942381512
Name:BIRGANI, BEHNAM (DO)
Entity Type:Individual
Prefix:MR
First Name:BEHNAM
Middle Name:
Last Name:BIRGANI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:BEHNAM
Other - Middle Name:
Other - Last Name:BIRGANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:4611 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3817
Mailing Address - Country:US
Mailing Address - Phone:954-491-4888
Mailing Address - Fax:
Practice Address - Street 1:4602 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5206
Practice Address - Country:US
Practice Address - Phone:954-491-4888
Practice Address - Fax:954-202-0504
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007073207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252376100Medicaid
FL380001376OtherRAILROAD MEDICARE
FL8468488OtherMEDICARE NSC
FL27514OtherWELLCARE
FL249132OtherAVMED
FL57293OtherBCBS
FL249132OtherAVMED
FL57293OtherBCBS