Provider Demographics
NPI:1174606529
Name:HRACHIAN HAFTEVANI, HAKOP (MD)
Entity type:Individual
Prefix:
First Name:HAKOP
Middle Name:
Last Name:HRACHIAN HAFTEVANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HAKOP
Other - Middle Name:HAFTEVANI
Other - Last Name:HRACHIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 566597
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-6597
Mailing Address - Country:US
Mailing Address - Phone:305-663-3377
Mailing Address - Fax:305-663-3097
Practice Address - Street 1:7000 SW 97TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1492
Practice Address - Country:US
Practice Address - Phone:305-663-3377
Practice Address - Fax:305-663-3097
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89775207RC0001X, 2251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6608015OtherCIGNA
FL108995300Medicaid
FL1060036OtherCAREPLUS
FL311128OtherAVMED
FL0174566OtherGHI
FLSG086864OtherVISTA
FL17729OtherBLUE CROSS BLUE SHIELD
FL0174566OtherGHI
FLSG086864OtherVISTA