MEDICARE: DR. IRADJ - ANSARI

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	282N00000X	General Acute Care Hospital	128460	NY

General Provider Information

NPI Number	:	1639261159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRADJ - ANSARI

Provider Business Mailing Address
First Line	:	16450 GULF BLVD
Second Line	:	APT 263
City	:	NORTH REDINGTON BEACH
State	:	FL
Zip	:	33708-1575
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16450 GULF BLVD
Second Line	:	APT 263
City	:	NORTH REDINGTON BEACH
State	:	FL
Zip	:	33708-1575
Country	:	US
Telephone Number	:	727-398-6661
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	07/08/2007

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