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NPI Code Detail

MEDICARE: ETAI FUNK MD FACS PA

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
1207YX0905XOtolaryngology/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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