Provider Demographics
NPI:1396731121
Name:ILKHANIPOUR, KAVEH (MD)
Entity type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:ILKHANIPOUR
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 1:1501 LOCUST ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5136
Mailing Address - Country:US
Mailing Address - Phone:412-232-5771
Mailing Address - Fax:412-232-5768
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:412-232-8222
Practice Address - Fax:412-232-5768
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037002E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012886220001Medicaid
PA0491149OtherAETNA PIN
PA567777JK6OtherMCR GROUP PTAN
PA1233295OtherCIGNA
PA930009484OtherRR MEDICARE
PA1513388OtherGATEWAY
PA251809OtherUPMC
PA000000083371OtherUNISON
PA5627170OtherAETNA PVN
PA537667OtherBCBS
PA0012886220001Medicaid
PA1513388OtherGATEWAY