Provider Demographics
NPI: | 1427019942 |
---|---|
Name: | SULAK, LAURA EVE (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | LAURA |
Middle Name: | EVE |
Last Name: | SULAK |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 947 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77001-0947 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 832-355-2942 |
Mailing Address - Fax: | 832-355-4232 |
Practice Address - Street 1: | 6720 BERTNER AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77030 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-785-8357 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2006-04-01 |
Last Update Date: | 2025-09-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | G8453 | 207ZH0000X, 207ZP0102X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207ZH0000X | Allopathic & Osteopathic Physicians | Pathology | Hematology |
No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
8A4196 | Medicare ID - Type Unspecified | ||
E14663 | Medicare UPIN | ||
8820J5 | Medicare ID - Type Unspecified |