Provider Demographics
NPI:1578842571
Name:KHAVARI, NAGHMEH LILLY (DPM)
Entity Type:Individual
Prefix:DR
First Name:NAGHMEH
Middle Name:LILLY
Last Name:KHAVARI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4221 MEDICAL PKWY STE 450
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4542
Mailing Address - Country:US
Mailing Address - Phone:469-998-3668
Mailing Address - Fax:469-444-6065
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:469-998-3668
Practice Address - Fax:469-444-6065
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2081213ES0103X, 213ES0103X
MI5901002423213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery