Provider Demographics
NPI:1366788218
Name:BOZORGI, SIAVOSH (MD)
Entity type:Individual
Prefix:
First Name:SIAVOSH
Middle Name:
Last Name:BOZORGI
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 1:430 GRAND BAY DR
Mailing Address - Street 2:UNIT 1203
Mailing Address - City:KEY BISCAYNE
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1918
Mailing Address - Country:US
Mailing Address - Phone:305-361-5878
Mailing Address - Fax:
Practice Address - Street 1:430 GRAND BAY DR
Practice Address - Street 2:UNIT 1203
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1918
Practice Address - Country:US
Practice Address - Phone:305-361-5878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35033234208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)