Provider Demographics
NPI:1083061287
Name:CLEAR LAKE PODIATRY PLLC
Entity Type:Organization
Organization Name:CLEAR LAKE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BABA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-724-5391
Mailing Address - Street 1:PO BOX 58704
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8704
Mailing Address - Country:US
Mailing Address - Phone:281-724-5391
Mailing Address - Fax:281-724-1861
Practice Address - Street 1:600 N KOBAYASHI STE 308
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-5391
Practice Address - Fax:281-724-1861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty