Provider Demographics
NPI:1972585586
Name:BADIZADEGAN, KAMRAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:BADIZADEGAN
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 1:7512 DR PHILLIPS BLVD STE 50-523
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5420
Mailing Address - Country:US
Mailing Address - Phone:617-680-4215
Mailing Address - Fax:
Practice Address - Street 1:12252 MONTALCINO CIR
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5672
Practice Address - Country:US
Practice Address - Phone:617-680-4215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS99264207ZC0006X
OH35.129581207ZP0101X, 207ZP0213X
FL111484207ZP0101X, 207ZP0213X, 207ZC0008X
FL97007207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0008XAllopathic & Osteopathic PhysiciansPathologyClinical Informatics
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA766417OtherTUFTS HEALTH PLAN
MA3165698Medicaid
OHH506762OtherMEDICARE PTAN
MAJ17701OtherBCBS MA
MA3165698Medicaid