Provider Demographics
NPI:1770639478
Name:HOUSTON INFECTIOUS DISEASE ASSOCIATED
Entity Type:Organization
Organization Name:HOUSTON INFECTIOUS DISEASE ASSOCIATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURGERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-791-4882
Mailing Address - Street 1:6624 FANNIN ST
Mailing Address - Street 2:SUITE 1410
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2312
Mailing Address - Country:US
Mailing Address - Phone:713-791-4882
Mailing Address - Fax:713-791-4159
Practice Address - Street 1:6624 FANNIN ST
Practice Address - Street 2:SUITE 1410
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2312
Practice Address - Country:US
Practice Address - Phone:713-791-4882
Practice Address - Fax:713-791-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9045207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QW03OtherBLUE CROSS
TXCS4960OtherMEDICARE RR
TX084604001Medicaid
TX00QW03OtherBLUE CROSS