Provider Demographics
NPI:1740662147
Name:BAHARLOO, BABAK
Entity type:Individual
Prefix:
First Name:BABAK
Middle Name:
Last Name:BAHARLOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SUGAR LAKES DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3446
Mailing Address - Country:US
Mailing Address - Phone:713-582-8968
Mailing Address - Fax:
Practice Address - Street 1:11515 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-2905
Practice Address - Country:US
Practice Address - Phone:713-728-3117
Practice Address - Fax:713-728-2212
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2129213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery