Provider Demographics
NPI:1659560852
Name:JENNIFER L CHILEK MD PA
Entity Type:Organization
Organization Name:JENNIFER L CHILEK MD PA
Other - Org Name:STONE CREEK FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHILEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-582-0220
Mailing Address - Street 1:19782 HIGHWAY 105 W
Mailing Address - Street 2:SUI 111
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-3103
Mailing Address - Country:US
Mailing Address - Phone:936-582-0220
Mailing Address - Fax:936-582-0222
Practice Address - Street 1:19782 HIGHWAY 105 W
Practice Address - Street 2:SUI 111
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-3103
Practice Address - Country:US
Practice Address - Phone:936-582-0220
Practice Address - Fax:936-582-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00063XMedicare PIN