| Pourkavoos Medical Center, Llc | |
|
35 Nod Rd Suite 205 Avon CT 06001-3826 | |
| (860) 676-0090 | |
| (860) 676-0040 |
| Full Name | Pourkavoos Medical Center, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 35 Nod Rd, Avon, Connecticut |
| Authorized Official Name and Position | Khosro Pourkavoos (OWNER) |
| Authorized Official Contact | 8606760090 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pourkavoos Medical Center, Llc 35 Nod Rd Suite 205 Avon CT 06001-3826 Ph: (860) 676-0090 | Pourkavoos Medical Center, Llc 35 Nod Rd Suite 205 Avon CT 06001-3826 Ph: (860) 676-0090 |
| NPI Number | 1346543642 |
|---|---|
| Provider Enumeration Date | 12/09/2010 |
| Last Update Date | 12/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346543642 | NPI | - | NPPES |
| 001397092 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 039709 (Connecticut) | Primary |
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