Provider Demographics
NPI:1841721628
Name:DABIRI, IMAN (MD)
Entity type:Individual
Prefix:DR
First Name:IMAN
Middle Name:
Last Name:DABIRI
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 1:1875 NW 167TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PNES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2015
Mailing Address - Country:US
Mailing Address - Phone:954-937-0035
Mailing Address - Fax:
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4668
Practice Address - Country:US
Practice Address - Phone:954-414-9750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012743922084N0400X
390200000X
FLME1483922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program