Healthcare Provider Details

I. General information

NPI: 1750364071
Provider Name (Legal Business Name): HEDAYATOLLAH ZAGHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JOHN F KENNEDY DR SUITE 110
ATLANTIS FL
33462-1146
US

IV. Provider business mailing address

110 JOHN F KENNEDY DR SUITE 110
ATLANTIS FL
33462-1146
US

V. Phone/Fax

Practice location:
  • Phone: 561-641-7825
  • Fax: 561-641-3748
Mailing address:
  • Phone: 561-641-7825
  • Fax: 561-641-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME66610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: