Provider Demographics
NPI:1457668972
Name:DIGESTIVE HEALTH GROUP OF THE GULF COAST, PLLC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH GROUP OF THE GULF COAST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:KUDISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-777-9995
Mailing Address - Street 1:6699 CHIMNEY ROCK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5358
Mailing Address - Country:US
Mailing Address - Phone:713-777-9995
Mailing Address - Fax:713-777-0100
Practice Address - Street 1:6699 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5358
Practice Address - Country:US
Practice Address - Phone:713-777-9995
Practice Address - Fax:713-800-7443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-03
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1289207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty