Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E1-0000235 | DE |
N | 213ES0103X | Foot & Ankle Surgery | E1-0000235 | DE |
N | 213ES0103X | Foot & Ankle Surgery | SC006482 | PA |
NPI | 1164859336 |
---|---|
Provider Name | Allen Mirzaei |
First Address | Seaford, DE 19973-2339 |
Second Address | Seaford, DE 19973-2339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2013 |
Last Update Date | 28/09/2016 |