Provider Demographics
NPI:1275602799
Name:BAKHTARI, LADAN (MD)
Entity Type:Individual
Prefix:
First Name:LADAN
Middle Name:
Last Name:BAKHTARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5941 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-9001
Mailing Address - Country:US
Mailing Address - Phone:972-758-4455
Mailing Address - Fax:972-758-4433
Practice Address - Street 1:5941 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-9001
Practice Address - Country:US
Practice Address - Phone:972-758-4455
Practice Address - Fax:972-758-4433
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046492701Medicaid
TX83881YOtherBCBS
TX83881YOtherBCBS
TXG62820Medicare UPIN