MEDICARE: DR. STEVEN MICHAEL PETAK 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	G1147	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01242674	OTHER	TX	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1861493157	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861493157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN MICHAEL PETAK MD

Provider Business Mailing Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 1101
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-0006
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 FANNIN ST
Second Line	:	SUITE 1101
City	:	HOUSTON
State	:	TX
Zip	:	77030-2717
Country	:	US
Telephone Number	:	713-441-0006
Fax Number	:

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/13/2014

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Directions to “ DR. STEVEN MICHAEL PETAK MD” Practice Location

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