Provider Demographics
NPI:1710040183
Name:HOUSTON CENTER FOR INFECTIOUS DISEASES PA
Entity Type:Organization
Organization Name:HOUSTON CENTER FOR INFECTIOUS DISEASES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:PALAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-444-1303
Mailing Address - Street 1:1111 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3240
Mailing Address - Country:US
Mailing Address - Phone:281-444-1303
Mailing Address - Fax:281-444-5161
Practice Address - Street 1:1111 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 170
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-3240
Practice Address - Country:US
Practice Address - Phone:281-444-1303
Practice Address - Fax:281-444-5161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00758UMedicare PIN