Provider Demographics
NPI:1649466731
Name:MINA ZAHEDI INC
Entity type:Organization
Organization Name:MINA ZAHEDI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHEDI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:386-676-4410
Mailing Address - Street 1:1050 W GRANADA BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8154
Mailing Address - Country:US
Mailing Address - Phone:386-676-4410
Mailing Address - Fax:386-676-4490
Practice Address - Street 1:1050 W GRANADA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8154
Practice Address - Country:US
Practice Address - Phone:386-676-4410
Practice Address - Fax:386-676-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1982666814OtherINDIVIDUAL NPI
FL110231155OtherMEDICARE RAILROAD
FLK2990OtherMEDICARE GROUP PIN
FL1649466731OtherGROUP NPI
FL03248OtherBLUE CROSS BLUE SHIELD
FL03248OtherBLUE CROSS BLUE SHIELD
FLK2990OtherMEDICARE GROUP PIN