1376490490 NPI number — PREMIER HEALTH PRIMARY CARE PLLC

Table of content: DR. IZABELA JUSTYNA MARCZAK MD (NPI 1972244853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376490490 NPI number — PREMIER HEALTH PRIMARY CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER HEALTH PRIMARY CARE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1376490490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11702 GRANT RD STE F
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77429-5771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-766-8040
Provider Business Mailing Address Fax Number:
281-766-8041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11702 GRANT RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYPRESS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77429-5771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-766-8040
Provider Business Practice Location Address Fax Number:
281-766-8041
Provider Enumeration Date:
03/16/2026

Additional Information

Authorized Official

Authorized Official Last Name:
SUAREZ RIVAS
Authorized Official First Name:
MAYDELIS
Authorized Official Middle Name:
Authorized Official Title or Position:
FNP
Authorized Official Telephone Number:
281-766-8040

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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