Physician Compare National (NPI:1710095419)

HEALTHCARE PROVIDER: FEREYDOON MAHJOURI M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1710095419
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2466612221
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120402000407
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MAHJOURI
	Individual professional last name
Provider First Name	FEREYDOON
	Individual professional first name
Provider Middle Name	S
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1967
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HAND SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HAND SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	500 OSBORNE RD NE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 130
	Group Practice or individual's line 2 address
City	FRIDLEY
	Group Practice or individual's city
State	MN
	Group Practice or individual's state
Zip Code	554322767
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y