Healthcare Provider Details

I. General information

NPI: 1962698241
Provider Name (Legal Business Name): BABAK KAVIANI D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 SPICEWOOD SPRINGS RD STE K1
AUSTIN TX
78759-8600
US

IV. Provider business mailing address

PO BOX 91674
AUSTIN TX
78709-1674
US

V. Phone/Fax

Practice location:
  • Phone: 512-394-5108
  • Fax: 512-394-5109
Mailing address:
  • Phone: 512-394-5108
  • Fax: 512-394-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number1854
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1854
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: