MEDICARE: MOJGAN TAVAKOLI 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	213E00000X	Podiatrist	1549	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8B8721	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	752946496	OTHER	TX	COMMERCIAL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801847694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOJGAN TAVAKOLI DPM

Provider Business Mailing Address
First Line	:	4461 COIT RD
Second Line	:	SUITE 409
City	:	FRISCO
State	:	TX
Zip	:	75035-0526
Country	:	US
Telephone Number	:	972-712-7773
Fax Number	:	972-712-3134

Provider Business Practice Location Address
First Line	:	4461 COIT RD
Second Line	:	SUITE 409
City	:	FRISCO
State	:	TX
Zip	:	75035-0526
Country	:	US
Telephone Number	:	972-712-7773
Fax Number	:	972-712-3134

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

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	04/10/2008

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