MEDICARE: DR. RABIN KHERADPOUR 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
1	207R00000X	Internal Medicine Physician	A63649	CA
2	207R00000X	Internal Medicine Physician	P4661	TX

General Provider Information

NPI Number	:	1093718462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RABIN KHERADPOUR M.D.

Provider Business Mailing Address
First Line	:	2115 KRAMER LN
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78758-4013
Country	:	US
Telephone Number	:	512-978-9000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 S 1ST ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5466
Country	:	US
Telephone Number	:	512-978-9500
Fax Number	:	512-901-9708

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	12/01/2016

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