Provider Demographics
NPI:1689954745
Name:WESTLAKE IVF
Entity Type:Organization
Organization Name:WESTLAKE IVF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRYAR
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAVOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:512-579-2700
Mailing Address - Street 1:300 BEARDSLEY LN
Mailing Address - Street 2:BLDG B, STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-4945
Mailing Address - Country:US
Mailing Address - Phone:512-579-2700
Mailing Address - Fax:
Practice Address - Street 1:300 BEARDSLEY LN
Practice Address - Street 2:BLDG B, STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-4945
Practice Address - Country:US
Practice Address - Phone:512-579-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5277207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty