Provider Demographics
NPI:1750815742
Name:KATY ENDOCRINE CLINIC PA
Entity Type:Organization
Organization Name:KATY ENDOCRINE CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAIKRISHNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ALETI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-705-3897
Mailing Address - Street 1:23410 GRAND RESERVE DR STE 203
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-4986
Mailing Address - Country:US
Mailing Address - Phone:248-705-3897
Mailing Address - Fax:
Practice Address - Street 1:28431 TALL JUNIPER HILL DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-1957
Practice Address - Country:US
Practice Address - Phone:248-705-3897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6468207R00000X, 207RE0101X
TXN2365207R00000X, 207RC0200X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1295965507Medicare UPIN
MI1497770077Medicare UPIN