Provider Demographics
NPI:1104282359
Name:BARADARAN EBRAHIMI, KATAYOON (MD)
Entity type:Individual
Prefix:
First Name:KATAYOON
Middle Name:
Last Name:BARADARAN EBRAHIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATAYOON
Other - Middle Name:
Other - Last Name:BARADARAN EBRAHIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:701-234-2000
Mailing Address - Fax:
Practice Address - Street 1:1717 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4939
Practice Address - Country:US
Practice Address - Phone:701-461-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01788207W00000X
PAMD463064207W00000X
ND18004207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology