Healthcare Provider Details

I. General information

NPI: 1689954745
Provider Name (Legal Business Name): WESTLAKE IVF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BEARDSLEY LN BLDG B, STE 200
AUSTIN TX
78746-4945
US

IV. Provider business mailing address

300 BEARDSLEY LN BLDG B, STE 200
AUSTIN TX
78746-4945
US

V. Phone/Fax

Practice location:
  • Phone: 512-579-2700
  • Fax:
Mailing address:
  • Phone: 512-579-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberM5277
License Number StateTX

VIII. Authorized Official

Name: DR. SHAHRYAR K KAVOUSSI
Title or Position: MEDICAL DIRECTOR
Credential: M.D., M.P.H.
Phone: 512-579-2700