Provider Demographics
NPI:1861229106
Name:RAD GHARAVI MD PC
Entity type:Organization
Organization Name:RAD GHARAVI MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAD
Authorized Official - Middle Name:
Authorized Official - Last Name:GHARAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-456-5178
Mailing Address - Street 1:17945 HUNTING BOW CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5376
Mailing Address - Country:US
Mailing Address - Phone:813-449-1910
Mailing Address - Fax:813-925-9007
Practice Address - Street 1:17945 HUNTING BOW CIR STE 102
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5376
Practice Address - Country:US
Practice Address - Phone:813-449-1910
Practice Address - Fax:813-925-9007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAD GHARAVI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty