Provider Demographics
NPI:1659528032
Name:JOHN K BADLISSI MD PA
Entity Type:Organization
Organization Name:JOHN K BADLISSI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BADLISSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-722-1197
Mailing Address - Street 1:2400 HIGHWAY 365
Mailing Address - Street 2:SUITE 205
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6249
Mailing Address - Country:US
Mailing Address - Phone:409-722-1197
Mailing Address - Fax:409-722-1923
Practice Address - Street 1:2400 HIGHWAY 365
Practice Address - Street 2:SUITE 205
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6249
Practice Address - Country:US
Practice Address - Phone:409-722-1197
Practice Address - Fax:409-722-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty