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General NPI Number Information
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NPI Number | 1780896480
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Entity Type | Organization
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Legal Business Name | PROTEA HEALTH INC
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 17200 STATE HIGHWAY 249 SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77064-1184
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Country | US
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Telephone | 281-469-4156
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Fax | 281-469-7315
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Provider Business Mailing Address
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Address Line | 17200 STATE HIGHWAY 249 SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77064-1184
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Country | US
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Telephone | 281-469-4156
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Fax | 281-469-7315
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | THEODORE S PILISZEK
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Credential | M.D.
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Telephone | 281-469-4156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G1149
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License Number State | TX
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