Provider Demographics
NPI:1427019942
Name:SULAK, LAURA EVE (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:EVE
Last Name:SULAK
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:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77001-0947
Mailing Address - Country:US
Mailing Address - Phone:832-355-2942
Mailing Address - Fax:832-355-4232
Practice Address - Street 1:6720 BERTNER AVENUE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-785-8357
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8453207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
8A4196Medicare ID - Type Unspecified
E14663Medicare UPIN
8820J5Medicare ID - Type Unspecified