MEDICARE: ETAI FUNK MD FACS PA

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician

General Provider Information

NPI Number	:	1376853218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETAI FUNK MD FACS PA

Provider Business Mailing Address
First Line	:	952 ECHO LN STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2773
Country	:	US
Telephone Number	:	713-636-2757
Fax Number	:	281-888-4083

Provider Business Practice Location Address
First Line	:	952 ECHO LN STE 140
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2773
Country	:	US
Telephone Number	:	713-636-2757
Fax Number	:	281-888-4083

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. ETAI FUNK
Credential	:	MD
Telephone Number	:	713-501-9145

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	07/20/2018

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