Provider Demographics
NPI:1245325612
Name:PILISZEK, THEODORE S (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:S
Last Name:PILISZEK
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 1:13661 VERMARION ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070
Mailing Address - Country:US
Mailing Address - Phone:281-469-4156
Mailing Address - Fax:281-469-7315
Practice Address - Street 1:13661 VERMARION ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070
Practice Address - Country:US
Practice Address - Phone:281-469-4156
Practice Address - Fax:281-469-7315
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG1149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00EU06Medicare ID - Type Unspecified
B25512Medicare UPIN