MEDICARE: NASSER EFTEKHARI MD, PA

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	208100000X	Physical Medicine & Rehabilitation Physician	ME0050316	FL

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

General Provider Information

NPI Number	:	1801150842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NASSER EFTEKHARI MD, PA

Provider Business Mailing Address
First Line	:	6301 SW 112TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-4850
Country	:	US
Telephone Number	:	305-206-4726
Fax Number	:

Provider Business Practice Location Address
First Line	:	6301 SW 112TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33156-4850
Country	:	US
Telephone Number	:	305-206-4726
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. NASSER EFTEKHARI
Credential	:	MD,PA
Telephone Number	:	305-206-4726

Provider Enumeration Date	:	06/25/2012
Last Update Date	:	06/25/2012

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