Provider Demographics
NPI:1750356788
Name:FOROUZANDEH, BAHRAM (MD)
Entity type:Individual
Prefix:
First Name:BAHRAM
Middle Name:
Last Name:FOROUZANDEH
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 1:5000 KY ROUTE 321
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9113
Mailing Address - Country:US
Mailing Address - Phone:606-886-7645
Mailing Address - Fax:606-889-6206
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-886-7645
Practice Address - Fax:606-889-6206
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31205174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1541974OtherUMWA PIN NUMBER
KY1097430OtherPASSPORT HEALTH PIN #
KY5274306OtherAETNA PIN NUMBER
KY000000323512OtherANTHEM BC/BS PIN NUMBER
KY1171556OtherCHA HEALTH PIN NUMBER
KY6000540000OtherWV MEDICAID PIN NUMBER
KY64312051Medicaid
KYP00098815OtherRAILROAD MEDICARE PIN #
KY607181400OtherFEDERAL BLACK LUNG PIN #
KY6000540000OtherWV MEDICAID PIN NUMBER
KY1097430OtherPASSPORT HEALTH PIN #