Individual
KAVEH EHSANIPOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4750 WATERS AVE STE 452, SAVANNAH, GA 31404
(912) 350-5909
(912) 350-5914
Mailing address
4750 WATERS AVE STE 452, SAVANNAH, GA 31404-6235
(912) 350-5909
(912) 350-5914
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
020309
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000175458B
—
GA
05
—
000175458C
—
GA
01
—
10064418
AMERIGROUP
GA
01
—
349755
WELLCARE
GA
01
—
460003037
RR MEDICARE
GA
05
—
G20309
—
SC
Enumeration date
06/06/2006
Last updated
08/09/2018
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