Provider Demographics
NPI:1063567840
Name:SALEK, ATA T (MD)
Entity type:Individual
Prefix:DR
First Name:ATA
Middle Name:T
Last Name:SALEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1140 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-2737
Mailing Address - Country:US
Mailing Address - Phone:713-468-7911
Mailing Address - Fax:713-468-5195
Practice Address - Street 1:1140 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-2737
Practice Address - Country:US
Practice Address - Phone:713-468-7911
Practice Address - Fax:713-468-5195
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG9656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00033RMedicare PIN
TXC21488Medicare UPIN