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NPI Code Detail

MEDICARE: LALEH DAFTARIBESHELI M.D.

MEDICARE: LALEH DAFTARIBESHELI M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramBP10052388TX
22085R0202XDiagnostic Radiology PhysicianT8792TX

General Provider Information

NPI Number : 1013304153
Entity Type Code : Individual
Provider Name (Legal Business Name) : LALEH DAFTARIBESHELI M.D.
Provider Business Mailing Address
First Line : PO BOX 845347 DEPT OF RADIOLOGY MC 8896
Second Line :
City : DALLAS
State : TX
Zip : 75284-5347
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5323 HARRY HINES BLVD
Second Line :
City : DALLAS
State : TX
Zip : 75390-7201
Country : US
Telephone Number : 214-648-7760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/15/2015
Last Update Date : 09/07/2022

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