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General NPI Number Information
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NPI Number | 1619183936
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE PEDIATRIC CLINIC, P.A.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/19/2025
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Provider Practice Location Address
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Address Line | 16 PROFESSIONAL PARK DR
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City | WEBSTER
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State | TX
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Zip | 77598-4127
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Country | US
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Telephone | 281-332-3503
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Fax | 201-849-7650
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Provider Business Mailing Address
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Address Line | 16 PROFESSIONAL PARK DR
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City | WEBSTER
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State | TX
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Zip | 77598-4127
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Country | US
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Telephone | 281-332-3503
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Fax | 201-849-7650
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MICHELLE M COOK
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Credential |
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Telephone | 281-332-4830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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