Provider Demographics
NPI:1447572318
Name:ZELISKO, MICHAEL BLAINE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BLAINE
Last Name:ZELISKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5202 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3329
Mailing Address - Country:US
Mailing Address - Phone:713-669-9555
Mailing Address - Fax:
Practice Address - Street 1:6621 FANNIN ST # MC1-3270
Practice Address - Street 2:SUITE A300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-824-2296
Practice Address - Fax:832-825-1186
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN2895207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology