MEDICARE: MEMORIAL BONE & JOINT CLINIC LLP

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

General Provider Information

NPI Number	:	1275652679
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEMORIAL BONE & JOINT CLINIC LLP

Provider Business Mailing Address
First Line	:	4710 KATY FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2204
Country	:	US
Telephone Number	:	866-956-7846
Fax Number	:	713-691-9803

Provider Business Practice Location Address
First Line	:	4710 KATY FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-2204
Country	:	US
Telephone Number	:	866-956-7846
Fax Number	:	713-691-9803

Authorized Official
Title or Position	:	OWNER
Name	:	ZORAN CUPIC
Credential	:	MD
Telephone Number	:	866-956-7846

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	11/23/2020

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