MEDICARE: LAURA DETTI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	47592	TX
2	207VE0102X	Reproductive Endocrinology Physician	47592	TX
3	207VE0102X	Reproductive Endocrinology Physician	4301084580	MI
4	207VE0102X	Reproductive Endocrinology Physician	44077	TN
5	207VE0102X	Reproductive Endocrinology Physician	47930	TX
6	207VE0102X	Reproductive Endocrinology Physician	48636	TX
7	207V00000X	Obstetrics & Gynecology Physician	47930	TX

General Provider Information

NPI Number	:	1619042462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DETTI MD

Provider Business Mailing Address
First Line	:	6651 MAIN ST STE 1020
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2351
Country	:	US
Telephone Number	:	832-826-7313
Fax Number	:

Provider Business Practice Location Address
First Line	:	1504 TAUB LOOP
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-1608
Country	:	US
Telephone Number	:	713-798-1750
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	05/12/2025

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Directions to “ LAURA DETTI MD” Practice Location

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