Healthcare Provider Details

I. General information

NPI: 1235349432
Provider Name (Legal Business Name): MICHAEL POURDEHNAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1470 MADISON AVE BOX 1087
NEW YORK NY
10029-6542
US

IV. Provider business mailing address

171 E 74TH ST APT 5C
NEW YORK NY
10021-3221
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number246018
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: