Provider Demographics
NPI:1528052610
Name:PHILIP J STRAKA MD FACS PA
Entity type:Organization
Organization Name:PHILIP J STRAKA MD FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STRAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-540-8044
Mailing Address - Street 1:19701 KINGWOOD DR BLDG 2
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3773
Mailing Address - Country:US
Mailing Address - Phone:281-540-8044
Mailing Address - Fax:281-540-1164
Practice Address - Street 1:19701 KINGWOOD DR BLDG 2
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3773
Practice Address - Country:US
Practice Address - Phone:281-540-8044
Practice Address - Fax:281-540-1164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9182208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G82083Medicare UPIN
00130VMedicare ID - Type Unspecified