Provider Demographics
NPI:1265461941
Name:BAZARGAN, SADAF (MD)
Entity type:Individual
Prefix:
First Name:SADAF
Middle Name:
Last Name:BAZARGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17551 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4521
Mailing Address - Country:US
Mailing Address - Phone:813-454-4044
Mailing Address - Fax:813-265-3937
Practice Address - Street 1:17551 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4521
Practice Address - Country:US
Practice Address - Phone:813-454-4044
Practice Address - Fax:813-265-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME890132084N0400X, 2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268419500Medicaid
FL82620OtherBLUE CROSS BLUE SHIELD
FLH99229Medicare UPIN
FL268419500Medicaid