1518075357 NPI number — SUZANNE LASEK-NESSELQUIST MD

Table of content: SUZANNE LASEK-NESSELQUIST MD (NPI 1518075357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518075357 NPI number — SUZANNE LASEK-NESSELQUIST MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LASEK-NESSELQUIST
Provider First Name:
SUZANNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1518075357
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 BISSONNET STREET
Provider Second Line Business Mailing Address:
SUITE 297
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77005-2153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-662-2777
Provider Business Mailing Address Fax Number:
713-665-6227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 BISSONNET STREET
Provider Second Line Business Practice Location Address:
SUITE 297
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77005-2153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-662-2777
Provider Business Practice Location Address Fax Number:
833-428-3635
Provider Enumeration Date:
08/29/2006

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: 208M00000X , with the licence number:  N2619 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: N2619 , 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: P00744698 . This is a "MEDICARE RAILROAD PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BV154 . This is a "BLUE CROSS BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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