=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528052610
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PHILIP J STRAKA MD FACS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2005
-----------------------------------------------------
Last Update Date | 02/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19701 KINGWOOD DR BLDG 2
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-3773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-540-8044
-----------------------------------------------------
Fax | 281-540-1164
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19701 KINGWOOD DR BLDG 2
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-3773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-540-8044
-----------------------------------------------------
Fax | 281-540-1164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PHILIP JOSEPH STRAKA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 281-540-8044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | K9182
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------