Basic Information
| Provider Information | |||||||||
| NPI: | 1770673428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADICKES | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | STEPHEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134861880 | ||||||||
| FaxNumber: | 7135127244 | ||||||||
| Practice Location | |||||||||
| Address1: | 7200 CAMBRIDGE ST FL 10 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770304202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139866016 | ||||||||
| FaxNumber: | 7139866001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | M3840 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01042041 | 01 | TX | AMERIGROUP | OTHER | 8W7163 | 01 | TX | BCBS | OTHER | P00435684 | 01 | TX | RAILROAD MEDICARE | OTHER |