Provider Demographics
NPI:1083354302
Name:TALEB-HAGHIPOOR, KASRA
Entity Type:Individual
Prefix:
First Name:KASRA
Middle Name:
Last Name:TALEB-HAGHIPOOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 COUNTRY CLUB WAY APT M13
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-1834
Mailing Address - Country:US
Mailing Address - Phone:865-216-6711
Mailing Address - Fax:
Practice Address - Street 1:8400 COUNTRY CLUB WAY APT M13
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-1834
Practice Address - Country:US
Practice Address - Phone:865-216-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant