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General NPI Number Information
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NPI Number | 1669904173
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Entity Type | Individual
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Provider Name | LINDSEY HOPE TAVAKOLIAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 521 W SOUTHLAKE BLVD STE 175
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6175
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Country | US
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Telephone | 817-820-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 800 8TH AVE STE 400
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City | FORT WORTH
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State | TX
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Zip | 76104-2613
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Country | US
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Telephone | 817-820-0000
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | U0204
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | U0204
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License Number State | TX
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