MEDICARE: MR. BORNA KAVOUSI 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1235579582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BORNA KAVOUSI M.D.

Provider Business Mailing Address
First Line	:	2146 BELCOURT AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3504
Country	:	US
Telephone Number	:	615-936-0625
Fax Number	:

Provider Business Practice Location Address
First Line	:	VANDERBILT UNIVERSITY MEDICAL CTR
Second Line	:	1161 21ST AVE S, CCC-4312 MCN
City	:	NASHVILLE
State	:	TN
Zip	:	37232-2730
Country	:	US
Telephone Number	:	615-343-6642
Fax Number	:	615-322-0689

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	07/01/2013

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