MEDICARE: CLEAR LAKE NEUROLOGY PLLC

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	H1934	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	:	1134209455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEAR LAKE NEUROLOGY PLLC

Provider Business Mailing Address
First Line	:	17000 EL CAMINO REAL
Second Line	:	#205
City	:	HOUSTON
State	:	TX
Zip	:	77058-2636
Country	:	US
Telephone Number	:	281-218-7660
Fax Number	:	281-990-7883

Provider Business Practice Location Address
First Line	:	17000 EL CAMINO REAL
Second Line	:	#205
City	:	HOUSTON
State	:	TX
Zip	:	77058-2636
Country	:	US
Telephone Number	:	281-218-7660
Fax Number	:	281-990-7883

Authorized Official
Title or Position	:	OWNER
Name	:	LEANNE BURNETT
Credential	:	M.D.
Telephone Number	:	281-218-7660

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	04/15/2010

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Directions to “CLEAR LAKE NEUROLOGY PLLC ” Practice Location

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