Provider Demographics
NPI:1053471854
Name:SPIVAK, HADAR (MD)
Entity Type:Individual
Prefix:DR
First Name:HADAR
Middle Name:
Last Name:SPIVAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ
Mailing Address - Street 2:#1470
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:713-520-8900
Mailing Address - Fax:713-520-8905
Practice Address - Street 1:1200 BINZ
Practice Address - Street 2:#1470
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-520-8900
Practice Address - Fax:713-520-8905
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5217208600000X
TX5217208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096361302Medicaid
TXK5217OtherTX MED LIC
TXG91199Medicare UPIN