MEDICARE: DR. NICK J PATZAKIS D.O.

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	204C00000X	Sports Medicine (Neuromusculoskeletal Medicine) Physician	C7410	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063562635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICK J PATZAKIS D.O.

Provider Business Mailing Address
First Line	:	9725 HOMESTEAD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-4403
Country	:	US
Telephone Number	:	713-633-7020
Fax Number	:	713-633-5597

Provider Business Practice Location Address
First Line	:	9725 HOMESTEAD RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-4403
Country	:	US
Telephone Number	:	713-633-7020
Fax Number	:	713-633-5597

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	05/19/2008

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