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General NPI Number Information
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NPI Number | 1083354302
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Entity Type | Individual
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Provider Name | KASRA TALEB-HAGHIPOOR
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Gender | Male
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1265 UNION AVE 4 SHORB TOWER
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City | MEMPHIS
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State | TN
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Zip | 38104
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Country | US
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Telephone | 901-478-9183
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Fax | 901-478-8957
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE STE 330
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City | MEMPHIS
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State | TN
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Zip | 38104-6655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5156
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License Number State | TN
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