Provider Demographics
NPI:1659647311
Name:DZIADEK, OLIVIA LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:LISA
Last Name:DZIADEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6410 FANNIN ST
Mailing Address - Street 2:STE 1200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-5304
Mailing Address - Country:US
Mailing Address - Phone:832-623-9768
Mailing Address - Fax:281-422-1434
Practice Address - Street 1:2301 HOLMES ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2640
Practice Address - Country:US
Practice Address - Phone:816-404-4175
Practice Address - Fax:816-404-0003
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ8467207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty