Healthcare Provider Details

I. General information

NPI: 1730613530
Provider Name (Legal Business Name): PEAK NEURODIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SOUTHWEST FWY STE 410
HOUSTON TX
77027-7422
US

IV. Provider business mailing address

PO BOX 27803
HOUSTON TX
77227-7803
US

V. Phone/Fax

Practice location:
  • Phone: 713-255-5097
  • Fax: 713-626-2337
Mailing address:
  • Phone: 713-255-5097
  • Fax: 713-626-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: BLAKE SCHANZER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 713-255-5097