Provider Demographics
NPI:1861494668
Name:STADE, EILEEN C (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:C
Last Name:STADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:8200 WEDNESBURY LN
Mailing Address - Street 2:SUITE 485
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-2925
Mailing Address - Country:US
Mailing Address - Phone:713-981-9989
Mailing Address - Fax:713-981-7019
Practice Address - Street 1:8200 WEDNESBURY LN
Practice Address - Street 2:SUITE 485
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-2925
Practice Address - Country:US
Practice Address - Phone:713-981-9989
Practice Address - Fax:713-981-7019
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF2035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8564B8Medicare ID - Type Unspecified
TXC22156Medicare UPIN