MEDICARE: DR. MARK JOHN NETOSKIE 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	208000000X	Pediatrics Physician	H2639	TX

General Provider Information

NPI Number	:	1275575177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK JOHN NETOSKIE M.D.

Provider Business Mailing Address
First Line	:	4614 SHETLAND LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6208
Country	:	US
Telephone Number	:	713-703-3085
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 POST OAK BLVD
Second Line	:	SUITE 700
City	:	HOUSTON
State	:	TX
Zip	:	77056-5784
Country	:	US
Telephone Number	:	713-576-4465
Fax Number	:	860-697-7990

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/20/2011

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