Provider Demographics
NPI:1285961680
Name:MIRSAEIDI, MEHDI (MD)
Entity type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:MIRSAEIDI
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 1:1600 NW 10TH AVE # 7060A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1015
Mailing Address - Country:US
Mailing Address - Phone:240-383-7539
Mailing Address - Fax:
Practice Address - Street 1:1600 NW 10TH AVE # 7060A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1015
Practice Address - Country:US
Practice Address - Phone:240-383-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 124903207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease