MEDICARE: KAMBIZ JAHADI MD

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	208C00000X	Colon & Rectal Surgery Physician	K6019	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00391G	OTHER	TX	BCBS IDENTIFIER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407947021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMBIZ JAHADI MD

Provider Business Mailing Address
First Line	:	1402 CHISHOLM TRL STE C
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2903
Country	:	US
Telephone Number	:	512-248-9090
Fax Number	:

Provider Business Practice Location Address
First Line	:	1402 CHISHOLM TRL STE C
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2903
Country	:	US
Telephone Number	:	512-248-9090
Fax Number	:

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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