Provider Demographics
NPI:1467152389
Name:HAVER, MALEK KRCO
Entity Type:Individual
Prefix:
First Name:MALEK
Middle Name:KRCO
Last Name:HAVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-3789
Mailing Address - Country:US
Mailing Address - Phone:832-341-7472
Mailing Address - Fax:
Practice Address - Street 1:1401 ST JOSEPH PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8301
Practice Address - Country:US
Practice Address - Phone:713-757-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX942839163W00000X
TX1138338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse