Healthcare Provider Details

I. General information

NPI: 1164803375
Provider Name (Legal Business Name): NICHOLAS PATRICK STETKEVICH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15400 SOUTHWEST FWY STE 100
SUGAR LAND TX
77478-3876
US

IV. Provider business mailing address

2212 W HOLCOMBE BLVD
HOUSTON TX
77030-2088
US

V. Phone/Fax

Practice location:
  • Phone: 281-494-7010
  • Fax: 832-825-3689
Mailing address:
  • Phone: 408-355-0924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number007585
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS6061
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberS6061
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: