Provider Demographics
NPI:1972549459
Name:VITENAS, POVILAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:POVILAS
Middle Name:
Last Name:VITENAS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:VITENAS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4208 RICHMOND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6839
Mailing Address - Country:US
Mailing Address - Phone:281-484-0088
Mailing Address - Fax:281-484-7717
Practice Address - Street 1:4208 RICHMOND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6839
Practice Address - Country:US
Practice Address - Phone:281-484-0088
Practice Address - Fax:281-484-7717
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB89680Medicare UPIN
TXOOL53XMedicare ID - Type Unspecified