MEDICARE: BABAK BAHARLOO

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	213ES0103X	Foot & Ankle Surgery Podiatrist	2129	TX
2	213E00000X	Podiatrist	2129	TX

General Provider Information

NPI Number	:	1740662147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABAK BAHARLOO

Provider Business Mailing Address
First Line	:	1035 SUGAR LAKES DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3446
Country	:	US
Telephone Number	:	713-582-8968
Fax Number	:

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	:	06/22/2015
Last Update Date	:	09/08/2015

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Directions to “ BABAK BAHARLOO ” Practice Location

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