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General NPI Number Information
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NPI Number | 1093993909
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Entity Type | Organization
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Legal Business Name | MEMORIAL PULMONOLOGY PA
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 04/24/2014
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Provider Practice Location Address
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Address Line | 10837 KATY FWY SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77079-2207
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Country | US
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Telephone | 832-325-1200
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Fax | 713-984-8260
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Provider Business Mailing Address
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Address Line | 10837 KATY FWY SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77079-2207
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Country | US
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Telephone | 832-325-1200
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Fax | 713-984-8260
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Authorized Official
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Title or Position | DIRECTOR
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Name | ANATOLI N KRASKO
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Credential | MD
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Telephone | 832-325-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L7782
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | L7782
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | L7782
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License Number State | TX
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