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General NPI Number Information
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NPI Number | 1376285999
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR ADVANCED THORACIC SURGERY
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Dates
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Enumeration Date | 04/13/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 6718 LAKE NONA BLVD
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City | ORLANDO
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State | FL
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Zip | 32827-7982
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Country | US
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Telephone | 407-747-1899
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Fax |
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Provider Business Mailing Address
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Address Line | 5092 ISLEWORTH COUNTRY CLUB DR
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City | WINDERMERE
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State | FL
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Zip | 34786-8920
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Country | US
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Telephone | 202-841-7304
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FARID GHARAGOZLOO
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Credential | MD
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Telephone | 407-747-1899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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