Provider Demographics
NPI:1093718462
Name:KHERADPOUR, RABIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RABIN
Middle Name:
Last Name:KHERADPOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 KRAMER LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-4013
Mailing Address - Country:US
Mailing Address - Phone:512-978-9000
Mailing Address - Fax:
Practice Address - Street 1:2529 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5466
Practice Address - Country:US
Practice Address - Phone:512-978-9500
Practice Address - Fax:512-901-9708
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63649207R00000X
TXP4661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68156Medicare UPIN