Basic Information
| Provider Information | |||||||||
| NPI: | 1558000836 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INFECTIOUS DISEASES CONSULTANTS OF NORTHWEST HOUSTON PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10703 WINDING ARBOR CT | ||||||||
| Address2: | |||||||||
| City: | CYPRESS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774337136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137758914 | ||||||||
| FaxNumber: | 8323081272 | ||||||||
| Practice Location | |||||||||
| Address1: | 13656 BRETON RIDGE ST | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770706081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134647555 | ||||||||
| FaxNumber: | 8323081272 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2022 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PANKOW | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 7137758914 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.