MEDICARE: DR. BANAFSHEH BAHARLOO DPM

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	213ES0131X	Foot Surgery Podiatrist	2095	TX
2	213ES0103X	Foot & Ankle Surgery Podiatrist	2095	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326307794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BANAFSHEH BAHARLOO DPM

Provider Business Mailing Address
First Line	:	11515 CHIMNEY ROCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-2905
Country	:	US
Telephone Number	:	713-728-3117
Fax Number	:	713-728-2212

Provider Business Practice Location Address
First Line	:	11515 CHIMNEY ROCK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77035-2905
Country	:	US
Telephone Number	:	713-728-3117
Fax Number	:	713-728-2212

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

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	05/27/2015

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