Healthcare Provider Details

I. General information

NPI: 1861690638
Provider Name (Legal Business Name): NASSER CHAHMIRZADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 IBIS COVE CIR
NAPLES FL
34119-7732
US

IV. Provider business mailing address

8338 IBIS COVE CIR
NAPLES FL
34119-7732
US

V. Phone/Fax

Practice location:
  • Phone: 239-961-0182
  • Fax:
Mailing address:
  • Phone: 239-455-7956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME 98318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: