1952458101 NPI number — ADLI J KARADSHEH M.D.

Table of content: ADLI J KARADSHEH M.D. (NPI 1952458101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952458101 NPI number — ADLI J KARADSHEH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARADSHEH
Provider First Name:
ADLI
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952458101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1344 S APOLLO BLVD STE 406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MELBOURNE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32901-3185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-253-4032
Provider Business Mailing Address Fax Number:
321-802-5599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6100 MINTON RD NW STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32907-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-724-1172
Provider Business Practice Location Address Fax Number:
321-984-1695
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RA0201X , with the licence number:  ME69302 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: ME69302 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 122490300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME69302 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K0802 . This is a "MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4301055026 . This is a "STATE OF MICHIGAN BOARD OF MEDICINE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 102289600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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