Provider Demographics
NPI:1053300087
Name:CHUMPITAZI, CORRIE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:ELIZABETH
Last Name:CHUMPITAZI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORRIE
Other - Middle Name:KLOPCIC
Other - Last Name:CHUMPITAZI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:12523 STONEY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9488
Mailing Address - Country:US
Mailing Address - Phone:617-913-2029
Mailing Address - Fax:713-436-4638
Practice Address - Street 1:6621 FANNIN ST # A-2210
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-2000
Practice Address - Fax:832-825-5424
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221254208000000X
TXM67092080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188482702Medicaid
TX8K0034Medicare PIN
TXTXB117096Medicare PIN
TX8K0640Medicare PIN