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Individual

BANAFSHEH KIANKHOOY FARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2780 CLEVELAND AVE STE 709, FORT MYERS, FL 33901-5857
(239) 343-3831
(239) 343-2301
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-3831
(239) 343-2301

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
ME119702
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ME119702
LICENSE
FL
Enumeration date
06/27/2011
Last updated
05/17/2018
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