MEDICARE: BEHNAM BIRGANI DO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1245987627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHNAM BIRGANI DO PA

Provider Business Mailing Address
First Line	:	4611 S UNIVERSITY DR
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33328-3817
Country	:	US
Telephone Number	:	954-491-4888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 S ANDREWS AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33316-1838
Country	:	US
Telephone Number	:	954-491-4888
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	BEHNAM BIRGANI
Credential	:	DO
Telephone Number	:	954-491-4888

Provider Enumeration Date	:	03/07/2022
Last Update Date	:	03/07/2022

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