Provider Demographics
NPI:1518224401
Name:ABTAHI, ALI REZA (DO)
Entity Type:Individual
Prefix:
First Name:ALI
Middle Name:REZA
Last Name:ABTAHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11816 INWOOD RD # 1400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-8011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5288 TOWNE SQUARE DR STE 150
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-0037
Practice Address - Country:US
Practice Address - Phone:469-293-8707
Practice Address - Fax:469-294-8707
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT06832086S0122X
390200000X
IN01086289A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program