Provider Demographics
NPI:1639120421
Name:TAVAKOLI KNAPP ASSOCIATES P.A.
Entity Type:Organization
Organization Name:TAVAKOLI KNAPP ASSOCIATES P.A.
Other - Org Name:FOOT AND ANKLE CENTER OF PLANO FRISCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HORST
Authorized Official - Middle Name:P
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-712-7773
Mailing Address - Street 1:5375 COIT RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-4911
Mailing Address - Country:US
Mailing Address - Phone:972-712-7773
Mailing Address - Fax:972-712-3134
Practice Address - Street 1:5375 COIT RD STE 100
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4911
Practice Address - Country:US
Practice Address - Phone:972-712-7773
Practice Address - Fax:972-712-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14856M401Medicaid
TX00918RMedicare PIN
TX4515300001Medicare NSC