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NPI Code Detail

MEDICARE: DR. KEVIN MAHDAVI IZADI DO

MEDICARE: DR. KEVIN MAHDAVI IZADI DO
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1386386001
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEVIN MAHDAVI IZADI DO
Provider Business Mailing Address
First Line : 86 W UNDERWOOD ST STE 202
Second Line :
City : ORLANDO
State : FL
Zip : 32806-1110
Country : US
Telephone Number : 321-841-8642
Fax Number : 407-872-0544
Provider Business Practice Location Address
First Line : 92 W MILLER ST
Second Line :
City : ORLANDO
State : FL
Zip : 32806-2036
Country : US
Telephone Number : 407-649-6876
Fax Number : 407-872-0544
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2022
Last Update Date : 04/12/2022

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