Provider Demographics
NPI:1417974965
Name:BRUSATORI, NIKA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:NIKA
Middle Name:ELIZABETH
Last Name:BRUSATORI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIKA
Other - Middle Name:ELIZABETH
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2431 NOTTINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-1409
Mailing Address - Country:US
Mailing Address - Phone:713-528-5304
Mailing Address - Fax:
Practice Address - Street 1:921 GESSNER RD
Practice Address - Street 2:MEMORIAL HERMAN MEMORIAL CITY EMERGENCY ROOM
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2501
Practice Address - Country:US
Practice Address - Phone:713-242-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075837207P00000X
TXL6418207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine