Provider Demographics
NPI:1710935184
Name:CZEKAJ, PHILIP S (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:S
Last Name:CZEKAJ
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 1:602 PINON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78260-7731
Mailing Address - Country:US
Mailing Address - Phone:210-495-4887
Mailing Address - Fax:210-495-1430
Practice Address - Street 1:602 PINON BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78260-7731
Practice Address - Country:US
Practice Address - Phone:210-495-4887
Practice Address - Fax:210-495-1430
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4946207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060NKOtherBCBS
TX137353214Medicaid
TXP00363406Medicare PIN
TX137353214Medicaid
TX612648Medicare PIN