Provider Demographics
NPI:1457399537
Name:PLISKA, JOHN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:PLISKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6636
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-6636
Mailing Address - Country:US
Mailing Address - Phone:361-694-5086
Mailing Address - Fax:361-855-9518
Practice Address - Street 1:3533 S. AMAMEDA
Practice Address - Street 2:SUITE 202
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411
Practice Address - Country:US
Practice Address - Phone:361-694-5086
Practice Address - Fax:361-855-9518
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH59482080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H9850OtherBCBSTX
TX118748604Medicaid
TX11887486OtherCSHCN
TX118748604Medicaid
TX11887486OtherCSHCN