Healthcare Provider Details

I. General information

NPI: 1710085089
Provider Name (Legal Business Name): AUSTIN ENDOMETRIOSIS & FEMALE INFERTILITY CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 JAMES CASEY ST SUITE A
AUSTIN TX
78145-1188
US

IV. Provider business mailing address

4303 JAMES CASEY ST SUITE A
AUSTIN TX
78145-1188
US

V. Phone/Fax

Practice location:
  • Phone: 512-444-1414
  • Fax: 512-444-5621
Mailing address:
  • Phone: 512-444-1414
  • Fax: 512-444-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberG2406
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG2406
License Number StateTX

VIII. Authorized Official

Name: DR. KEIKHOSROW M KAVOUSSI
Title or Position: OWNER
Credential: M.D.
Phone: 512-444-1414