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General NPI Number Information
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NPI Number | 1659078632
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Entity Type | Organization
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Legal Business Name | HENRY LEROY BURKHOLDER IV MD, PLLC
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 17450 ST LUKES WAY STE 230
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City | THE WOODLANDS
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State | TX
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Zip | 77384-8045
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Country | US
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Telephone | 281-843-8441
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Fax |
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Provider Business Mailing Address
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Address Line | 13100 WORTHAM CENTER DR FL 3
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City | HOUSTON
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State | TX
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Zip | 77065-5625
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Country | US
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Telephone | 713-737-5912
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Fax |
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Authorized Official
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Title or Position | VP BUSINESS OPERATIONS
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Name | PAUL TATE
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Credential |
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Telephone | 713-737-5912
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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