Healthcare Provider Details

I. General information

NPI: 1639120421
Provider Name (Legal Business Name): TAVAKOLI KNAPP ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5375 COIT RD STE 100
FRISCO TX
75035-4911
US

IV. Provider business mailing address

5375 COIT RD STE 100
FRISCO TX
75035-4911
US

V. Phone/Fax

Practice location:
  • Phone: 972-712-7773
  • Fax: 972-712-3134
Mailing address:
  • Phone: 972-712-7773
  • Fax: 972-712-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. HORST P KNAPP
Title or Position: CEO
Credential: DPM
Phone: 972-712-7773