Provider Demographics
NPI:1417946831
Name:SEKHAVAT, ABBASS (MD)
Entity Type:Individual
Prefix:
First Name:ABBASS
Middle Name:
Last Name:SEKHAVAT
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 1:399 W CAMPBELL RD
Mailing Address - Street 2:STE 406
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3595
Mailing Address - Country:US
Mailing Address - Phone:972-644-7115
Mailing Address - Fax:972-234-3946
Practice Address - Street 1:399 W CAMPBELL RD
Practice Address - Street 2:STE 406
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3595
Practice Address - Country:US
Practice Address - Phone:972-644-7115
Practice Address - Fax:972-234-3946
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2477207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B26329Medicare UPIN
00TJ11Medicare ID - Type Unspecified