Kamran Badizadegan, MD
Individual provider Active NPI Clinical Informatics (Pathology) Physician · Windermere, FL
NPI 1972585586 · NPPES record last updated Aug 19, 2022
Key facts
- NPI
- 1972585586
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Informatics (Pathology) Physician 207ZC0008X
- License
- 111484 (FL)
- Practice address
- 12252 Montalcino Cir
Windermere, FL 34786-5672 - Phone
- (617) 680-4215
- NPI assigned
- Nov 18, 2005
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S99264 | FL | MD | Clinical Pathology Physician |
| 35.129581 | OH | MD | Anatomic Pathology Physician |
| 97007 | FL | MD | Anatomic Pathology & Clinical Pathology Physician |
| 111484 | FL | MD | Pediatric Pathology Physician |
| 151157 | MA | MD | Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Pathology Physician | 207ZC0006X | S99264 | FL | |
| Anatomic Pathology Physician | 207ZP0101X | 35.129581 | OH | |
| Anatomic Pathology Physician | 207ZP0101X | 111484 | FL | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 97007 | FL | |
| Pediatric Pathology Physician | 207ZP0213X | 111484 | FL | |
| Pediatric Pathology Physician | 207ZP0213X | 35.129581 | OH | |
| Clinical Informatics (Pathology) Physician | 207ZC0008X | 111484 | FL | Yes |
Addresses
Primary practice location
12252 Montalcino Cir
Windermere, FL 34786-5672
Mailing address
7512 Dr Phillips Blvd Ste 50-523
Orlando, FL 32819-5420
Phone (617) 680-4215
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 766417 | Other | MA | TUFTS HEALTH PLAN |
| 3165698 | Medicaid | MA | |
| H506762 | Other | OH | MEDICARE PTAN |
| J17701 | Other | MA | BCBS MA |
Other providers in Windermere, FL
- Shruti Arora
- Moema Arruda
- Asher II LLC
- Atlantic Rehabilitation Medicine Associates PA
- Avec Amour Homecare LLC
- Bakkiam Subbiah Inc
- Allison Baltar
- Barinas Dental Associates Inc.
- Eddie Bartolomei
- Cristine Allison Beach
All providers in Windermere, FL · Clinical Informatics (Pathology) Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.