1093373219 NPI number — BROCK ADAM KAROLCIK MD

Table of content: VANESSA FIDALGO (NPI 1326320649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093373219 NPI number — BROCK ADAM KAROLCIK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAROLCIK
Provider First Name:
BROCK
Provider Middle Name:
ADAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093373219
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BAYLOR PLZ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77030-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6651 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
328-243-2788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  82638 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 801623 . This is a "TEXAS PHYSICIAN-IN-TRAINING PERMIT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 82638 . This is a "SC LIMITED MD LICENSE (SC MDLL)" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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