MEDICARE: NICHOLAS J STEPHANOU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	E3469	TX

General Provider Information

NPI Number	:	1063456515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS J STEPHANOU M.D.

Provider Business Mailing Address
First Line	:	5616 LAWNDALE AVE., SUITE A-110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023
Country	:	US
Telephone Number	:	713-921-0075
Fax Number	:	713-759-0912

Provider Business Practice Location Address
First Line	:	5616 LAWNDALE AVE., SUITE A-110
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77023
Country	:	US
Telephone Number	:	713-921-0075
Fax Number	:	713-759-0912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	07/09/2007

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