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NPI Code Detail

MEDICARE: BANAFSHEH KIANKHOOY FARD M.D.

MEDICARE: BANAFSHEH KIANKHOOY FARD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12080A0000XPediatric Adolescent Medicine PhysicianME119702FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ME119702OTHERFLLICENSE

General Provider Information

NPI Number : 1174819395
Entity Type Code : Individual
Provider Name (Legal Business Name) : BANAFSHEH KIANKHOOY FARD M.D.
Provider Business Mailing Address
First Line : PO BOX 2147
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-2147
Country : US
Telephone Number : 239-343-3831
Fax Number : 239-343-2301
Provider Business Practice Location Address
First Line : 2780 CLEVELAND AVE STE 709
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-5857
Country : US
Telephone Number : 239-343-3831
Fax Number : 239-343-2301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2011
Last Update Date : 05/17/2018

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