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General NPI Number Information
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NPI Number | 1730459769
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Entity Type | Organization
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Legal Business Name | FORT LAUDERDALE PSYCHIATRISTS LLC
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Dates
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Enumeration Date | 01/06/2012
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Last Update Date | 04/17/2012
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Provider Practice Location Address
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Address Line | 915 MIDDLE RIVER DR SUITE 317
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3544
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Country | US
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Telephone | 214-383-3200
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Fax | 214-383-3211
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Provider Business Mailing Address
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Address Line | 22 PRESTIGE CIR STE 200
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City | ALLEN
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State | TX
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Zip | 75002-3441
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Country | US
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Telephone | 214-383-3200
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Fax | 214-383-3211
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Authorized Official
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Title or Position | OWNER
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Name | HAIDEH MIRMESDAGH
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Credential | M.D.
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Telephone | 214-383-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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