MEDICARE: BABAFEMI BABAWANDE PRATT MD, MPH

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	2086S0129X	Vascular Surgery Physician	Q5072	TX
2	208600000X	Surgery Physician	2008018810	MO
3	2086S0129X	Vascular Surgery Physician	28194	MS
4	2086S0129X	Vascular Surgery Physician	2010018439	MO

General Provider Information

NPI Number	:	1174773873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABAFEMI BABAWANDE PRATT MD, MPH

Provider Business Mailing Address
First Line	:	8135 FOREST LN # 515057
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-2472
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 S HAMPTON RD STE 220B
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-2363
Country	:	US
Telephone Number	:	866-552-4866
Fax Number	:

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

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	02/04/2025

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