MEDICARE: BEHZOD ROSTAM 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	207Q00000X	Family Medicine Physician	4301096079	MI

General Provider Information

NPI Number	:	1902125677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEHZOD ROSTAM M.D.

Provider Business Mailing Address
First Line	:	262 S PORT CRESCENT ST
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-1328
Country	:	US
Telephone Number	:	989-493-9327
Fax Number	:	989-893-6412

Provider Business Practice Location Address
First Line	:	262 S PORT CRESCENT ST
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-1328
Country	:	US
Telephone Number	:	989-493-9327
Fax Number	:	989-623-0172

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

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	05/19/2025

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