Provider Demographics
NPI:1356674055
Name:SEDIGHI, TANNAZ (DPM)
Entity Type:Individual
Prefix:
First Name:TANNAZ
Middle Name:
Last Name:SEDIGHI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18735 THORNTREE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-2698
Mailing Address - Country:US
Mailing Address - Phone:310-993-4491
Mailing Address - Fax:
Practice Address - Street 1:2000 ESTERS RD
Practice Address - Street 2:STE 104
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-9580
Practice Address - Country:US
Practice Address - Phone:310-441-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2161213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01614593OtherRAILROAD MEDICARE
TX474407YUM7Medicare PIN
TX474407YPREMedicare PIN
TX474407YR1KMedicare PIN