Provider Demographics
NPI:1407354442
Name:CARROLLTON FOOT CENTER, PLLC
Entity Type:Organization
Organization Name:CARROLLTON FOOT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAGHMEH
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVARI-SALAMAT
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-458-0106
Mailing Address - Street 1:6925 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7550
Mailing Address - Country:US
Mailing Address - Phone:305-458-0106
Mailing Address - Fax:
Practice Address - Street 1:4221 MEDICAL PKWY STE 450
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4542
Practice Address - Country:US
Practice Address - Phone:972-662-8357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2081213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty