Provider Demographics
NPI: | 1982227245 |
---|---|
Name: | MAXXAM HORMONE & HEALTH PLLC |
Entity type: | Organization |
Organization Name: | MAXXAM HORMONE & HEALTH PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ANDREW |
Authorized Official - Middle Name: | PATRICK |
Authorized Official - Last Name: | KRETSCHMER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 281-883-4038 |
Mailing Address - Street 1: | 20031 W LAKE HOUSTON PKWY |
Mailing Address - Street 2: | |
Mailing Address - City: | HUMBLE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77346-3432 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 281-883-4038 |
Mailing Address - Fax: | 281-913-5295 |
Practice Address - Street 1: | 20031 W LAKE HOUSTON PKWY |
Practice Address - Street 2: | |
Practice Address - City: | HUMBLE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77346-3432 |
Practice Address - Country: | US |
Practice Address - Phone: | 281-883-4038 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-05-21 |
Last Update Date: | 2020-05-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Single Specialty |