Provider Demographics
NPI:1750514931
Name:NEW BRAUNFELS FOOT AND ANKLE SPECIALISTS, PLLC
Entity type:Organization
Organization Name:NEW BRAUNFELS FOOT AND ANKLE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BABAK KAVIANI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVIANI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:210-881-6733
Mailing Address - Street 1:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-0744
Mailing Address - Country:US
Mailing Address - Phone:210-881-6733
Mailing Address - Fax:210-881-6726
Practice Address - Street 1:1619 E COMMON ST
Practice Address - Street 2:SUITE 1202
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3452
Practice Address - Country:US
Practice Address - Phone:210-881-6733
Practice Address - Fax:210-881-6726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1854213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDQ3405OtherRAILROAD MEDICARE
TX2129157Medicaid
TX6307820001Medicare NSC
TX2129157Medicaid