Provider Demographics
NPI:1720143704
Name:STEPANIAK, PHILIP CAREY (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CAREY
Last Name:STEPANIAK
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 1:18635 POINT LOOKOUT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-4038
Mailing Address - Country:US
Mailing Address - Phone:281-333-9518
Mailing Address - Fax:
Practice Address - Street 1:1401 ST JOSEPH PKWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8301
Practice Address - Country:US
Practice Address - Phone:713-757-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1534282NC0060X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133748711Medicaid
TX8AC848OtherBCBSTX
TX1720143704OtherTRICARE SOUTH
TX8AC848OtherBCBSTX
TXC22229Medicare UPIN
TX133748711Medicaid
TXP00622022Medicare PIN