Provider Demographics
NPI:1962698241
Name:KAVIANI, BABAK (DPM)
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:KAVIANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91674
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-1674
Mailing Address - Country:US
Mailing Address - Phone:512-394-5108
Mailing Address - Fax:512-394-5109
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD STE K1
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8600
Practice Address - Country:US
Practice Address - Phone:512-394-5108
Practice Address - Fax:512-394-5109
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1854213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2129165Medicaid
TXPOO832863OtherRAILROAD MEDICARE
TX2129157Medicaid
TX70159751OtherDPS
TXPOO832863OtherRAILROAD MEDICARE
TX70159751OtherDPS
TX2129157Medicaid