Provider Demographics
NPI:1447543343
Name:GOLKAR-SISANI, FIROOZ (MD)
Entity type:Individual
Prefix:DR
First Name:FIROOZ
Middle Name:
Last Name:GOLKAR-SISANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 QUAIL HOLW
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3134
Mailing Address - Country:US
Mailing Address - Phone:860-466-6299
Mailing Address - Fax:
Practice Address - Street 1:309 WAWARME AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06114-1509
Practice Address - Country:US
Practice Address - Phone:860-466-6299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT15803207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services