Healthcare Provider Details

I. General information

NPI: 1407877384
Provider Name (Legal Business Name): BABAK ALEX VAKILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 W STATE ROAD 434 STE 190
LONGWOOD FL
32779-4976
US

IV. Provider business mailing address

2170 W STATE ROAD 434 STE 190
LONGWOOD FL
32779-4976
US

V. Phone/Fax

Practice location:
  • Phone: 407-990-1921
  • Fax: 407-990-1921
Mailing address:
  • Phone: 407-990-1921
  • Fax: 407-990-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME84848
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: