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General NPI Number Information
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NPI Number | 1508003286
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE SURGERY CENTER, PLLC
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Dates
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Enumeration Date | 01/16/2009
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Last Update Date | 09/23/2021
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Provider Practice Location Address
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Address Line | 14018 AESTHETIC CIR
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City | HOUSTON
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State | TX
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Zip | 77062-2373
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Country | US
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Telephone | 281-204-8017
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Fax | 281-204-8018
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Provider Business Mailing Address
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Address Line | 14018 AESTHETIC CIR
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City | HOUSTON
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State | TX
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Zip | 77062-2373
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Country | US
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Telephone | 281-204-8017
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Fax | 281-204-8018
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMIR M SUKKAR
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Credential | MD
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Telephone | 281-990-8487
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | J7218
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License Number State | TX
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