Healthcare Provider Details

I. General information

NPI: 1194235622
Provider Name (Legal Business Name): MEGAN MARIE PLOUZEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

12418 PINE VALLEY DR
KANSAS CITY KS
66109-3159
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax:
Mailing address:
  • Phone: 402-450-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15-02048
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: