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General NPI Number Information
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NPI Number | 1093072787
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Entity Type | Individual
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Provider Name | KASSRA - MICHAEL KHAZALPOUR M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 02/15/2025
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Provider Practice Location Address
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Address Line | 1000 36TH ST
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City | VERO BEACH
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State | FL
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Zip | 32960-4862
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Country | US
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Telephone | 772-567-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 1948 OCEAN RIDGE CIR
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City | VERO BEACH
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State | FL
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Zip | 32963-2730
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Country | US
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Telephone | 415-279-0947
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | D81285
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | ME130346
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME130346
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME130346
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License Number State | FL
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