Provider Demographics
NPI:1376853218
Name:ETAI FUNK MD FACS PA
Entity Type:Organization
Organization Name:ETAI FUNK MD FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ETAI
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-501-9145
Mailing Address - Street 1:952 ECHO LN STE 140
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2773
Mailing Address - Country:US
Mailing Address - Phone:713-636-2757
Mailing Address - Fax:281-888-4083
Practice Address - Street 1:952 ECHO LN STE 140
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2773
Practice Address - Country:US
Practice Address - Phone:713-636-2757
Practice Address - Fax:281-888-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty