Provider Demographics
NPI:1871884437
Name:RASTEGAR, FARBOD (MD)
Entity type:Individual
Prefix:
First Name:FARBOD
Middle Name:
Last Name:RASTEGAR
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 1:1537 S BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6703
Mailing Address - Country:US
Mailing Address - Phone:513-447-4772
Mailing Address - Fax:513-905-4377
Practice Address - Street 1:1537 S BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6703
Practice Address - Country:US
Practice Address - Phone:513-447-4772
Practice Address - Fax:513-905-4377
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI67494-20207X00000X
MIEMC0000651207X00000X
OH35.128329207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery