Provider Demographics
NPI:1083691562
Name:POWITZKY, AMY (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:POWITZKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 749
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-7465
Mailing Address - Fax:713-790-2996
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 749
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-7465
Practice Address - Fax:713-790-2996
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL71142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083691562OtherBLUE CROSS BLUE SHIELD
TX8K8589OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX210435801Medicaid
TX210435802Medicaid
TX8K8589OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX1083691562OtherBLUE CROSS BLUE SHIELD
TX8L25664Medicare PIN
TX8A9545Medicare PIN
TX8L24153Medicare PIN