Provider Demographics
NPI:1740256031
Name:BAKHTIAN, BIJAN J (MD)
Entity type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:J
Last Name:BAKHTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2780 CLEVELAND AVE
Mailing Address - Street 2:SUITE 819
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-5858
Mailing Address - Country:US
Mailing Address - Phone:239-336-6800
Mailing Address - Fax:239-336-6993
Practice Address - Street 1:2780 CLEVELAND AVE
Practice Address - Street 2:SUITE 819
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5858
Practice Address - Country:US
Practice Address - Phone:239-336-6800
Practice Address - Fax:239-336-6993
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME57192207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME57192OtherMEDICAL LICENSE
FLA97827Medicare UPIN
FL14312ZMedicare PIN