Provider Demographics
NPI:1174524219
Name:KAVEH, KIANOOSH (DO)
Entity type:Individual
Prefix:DR
First Name:KIANOOSH
Middle Name:
Last Name:KAVEH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8002
Mailing Address - Country:US
Mailing Address - Phone:941-505-8720
Mailing Address - Fax:941-505-8747
Practice Address - Street 1:3221 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8002
Practice Address - Country:US
Practice Address - Phone:941-505-8720
Practice Address - Fax:941-505-8747
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8229207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
001457915OtherBCBS HIGHMARK
IL651117748TOtherBCBS IL
GA2985402OtherAETNA BLUE BELL
7405063OtherMAMSI INS
FL0232474OtherCIGNA
PA2142967000OtherINDEPENDENCE BC PA
FL47881OtherBCBS
FLN279248Medicaid
FL265580200Medicaid
471501OtherTUFTS
KKA150339OtherBCBS EXCELLUS NY
FL651256OtherCOMBINED INS
MA0000ZCY746OtherBCBS MASS
FL7039169OtherAETNA
FL2142967000OtherAMERIHEALTH
FL30030181OtherKEYSTONE MERCY HEALTH
KKA150339OtherBCBS EXCELLUS NY
FL265580200Medicaid
FL30030181OtherKEYSTONE MERCY HEALTH
FLE5536ZMedicare UPIN