Provider Demographics
NPI:1710195417
Name:FLAK, KEITH STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:STEPHEN
Last Name:FLAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 MEDICAL PLAZA DR STE 260
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3275
Mailing Address - Country:US
Mailing Address - Phone:281-292-3999
Mailing Address - Fax:
Practice Address - Street 1:920 MEDICAL PLAZA DR STE 260
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3275
Practice Address - Country:US
Practice Address - Phone:281-292-3999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5054207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine