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6213 Colleyville Blvd Suite 1000 Colleyville TX 76034-6441 | |
| (214) 717-2772 | |
| (888) 927-0667 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 6213 Colleyville Blvd, Colleyville, Texas |
| Authorized Official Name and Position | Babak Attaran Rezaei (OWNER / PHYSICIAN) |
| Authorized Official Contact | 5598243737 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5813 St Andrews Ct Colleyville TX 76034-1267 Ph: (214) 717-2772 | 6213 Colleyville Blvd Suite 1000 Colleyville TX 76034-6441 Ph: (214) 717-2772 |
| NPI Number | 1770197477 |
|---|---|
| Provider Enumeration Date | 09/01/2020 |
| Last Update Date | 12/23/2024 |
| Certification Date | 12/23/2024 |
| Medicare PECOS PAC ID | 5597183368 |
|---|---|
| Medicare Enrollment ID | O20200910000778 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770197477 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Babak Attaran Rezaei |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205141041 PECOS PAC ID: 5799905394 Enrollment ID: I20181101002697 |
| Provider Name | Amy L Keneson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821572694 PECOS PAC ID: 8224460480 Enrollment ID: I20191111000271 |
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