Healthcare Provider Details

I. General information

NPI: 1821251893
Provider Name (Legal Business Name): MIRIAM CHRISTINE ZOLFOGHARY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 COUNTRY CLUB BLVD
CAPE CORAL FL
33990-2180
US

IV. Provider business mailing address

2234 COLONIAL BLVD ATTN: PAYER CONTRACTING & RELATIONS
FORT MYERS FL
33907-1412
US

V. Phone/Fax

Practice location:
  • Phone: 239-574-7454
  • Fax: 239-574-9439
Mailing address:
  • Phone: 239-931-7342
  • Fax: 239-931-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME101389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: