Individual
AMIR KOOHESTANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
500 N 4TH ST, ALBEMARLE, NC 28001-4024
(704) 550-5516
(704) 550-5404
Mailing address
500 N 4TH ST, ALBEMARLE, NC 28001-4024
(704) 438-7396
(704) 550-5404
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
200200936
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080187671
RAIL ROAD MEDICARE
—
01
—
131XT
BCBS
NC
05
—
89131XT
—
NC
Enumeration date
11/07/2005
Last updated
10/08/2014
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