Provider Demographics
NPI:1528057197
Name:KAIGHOBADI, JONI NOEL (DO)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:NOEL
Last Name:KAIGHOBADI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:
Other - Last Name:KAIGHOBADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4855 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-418-1683
Mailing Address - Fax:954-418-1698
Practice Address - Street 1:2500 E. HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-458-2572
Practice Address - Fax:954-354-8157
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274234900Medicaid
FLI47541Medicare UPIN
FLU6599WMedicare PIN