Healthcare Provider Details

I. General information

NPI: 1669498101
Provider Name (Legal Business Name): BAHRAM KAKAVAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 NEMOURS PKWY
ORLANDO FL
32827-7402
US

IV. Provider business mailing address

13535 NEMOURS PKWY
ORLANDO FL
32827-7402
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax: 407-567-5961
Mailing address:
  • Phone: 407-567-4000
  • Fax: 407-567-5961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME117075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: