Provider Demographics
NPI:1568470417
Name:BAHRAMI, MICHAEL M (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:BAHRAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2390 NE 186TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2789
Mailing Address - Country:US
Mailing Address - Phone:305-760-8400
Mailing Address - Fax:305-931-6166
Practice Address - Street 1:2390 NE 186TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2789
Practice Address - Country:US
Practice Address - Phone:305-760-8400
Practice Address - Fax:305-931-6166
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56556207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062430600Medicaid
FL09866UOtherFLORIDA BLUE SHIELD
FL062430600Medicaid
FL09866MMedicare PIN