Provider Demographics
NPI:1245457431
Name:FAIN, PETER MICHAEL (AUD, MBA)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:FAIN
Suffix:
Gender:M
Credentials:AUD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509B W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1533
Mailing Address - Country:US
Mailing Address - Phone:832-618-1010
Mailing Address - Fax:832-838-4232
Practice Address - Street 1:1509B W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1533
Practice Address - Country:US
Practice Address - Phone:832-618-1010
Practice Address - Fax:832-838-4232
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51161231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11317745OtherCAQH
TX036847402Medicaid
TX531239OtherBLUE CROSS BLUE SHIELD