Provider Demographics
NPI:1093072787
Name:KHAZALPOUR, KASSRA - MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:KASSRA - MICHAEL
Middle Name:
Last Name:KHAZALPOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1948 OCEAN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-2730
Mailing Address - Country:US
Mailing Address - Phone:415-279-0947
Mailing Address - Fax:
Practice Address - Street 1:1000 36TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4862
Practice Address - Country:US
Practice Address - Phone:772-567-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2025-02-15
Deactivation Date:2025-01-27
Deactivation Code:
Reactivation Date:2025-02-10
Provider Licenses
StateLicense IDTaxonomies
MDD81285207P00000X
FLME1303462083S0010X, 208D00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice