Healthcare Provider Details

I. General information

NPI: 1508353152
Provider Name (Legal Business Name): BLUEBONNET FOOT AND ANKLE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
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 TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: BABAK KAVIANI
Title or Position: PRESIDENT/OWNER
Credential: DPM
Phone: 512-394-5108