MEDICARE: DR. BAHRAM SEPEHRI 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
1	208000000X	Pediatrics Physician	01030087A	IN
2	208000000X	Pediatrics Physician	20885	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	351708493	OTHER	IN	TAX ID#

General Provider Information

NPI Number	:	1437145455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BAHRAM SEPEHRI M.D.

Provider Business Mailing Address
First Line	:	1425 STATE ST
Second Line	:	SUITE 100
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-4909
Country	:	US
Telephone Number	:	812-945-2229
Fax Number	:	812-949-2229

Provider Business Practice Location Address
First Line	:	230 E BROADWAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-2026
Country	:	US
Telephone Number	:	502-629-8990
Fax Number	:	502-394-3604

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	11/22/2021

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