Provider Demographics
NPI:1598759276
Name:AKHAVI, MAHMOOD S (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOOD
Middle Name:S
Last Name:AKHAVI
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 1:315 N SHILOH RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6682
Mailing Address - Country:US
Mailing Address - Phone:972-494-1100
Mailing Address - Fax:972-494-4909
Practice Address - Street 1:315 N SHILOH RD
Practice Address - Street 2:SUITE 103
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6682
Practice Address - Country:US
Practice Address - Phone:972-494-1100
Practice Address - Fax:972-494-4909
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX035340102Medicaid
TX172861001Medicaid
TX035340102Medicaid
TXB20820Medicare UPIN
TX8C6837Medicare ID - Type UnspecifiedINDIVIDUAL ID #