Provider Demographics
NPI:1518129535
Name:BROUSSARD, TAMEKA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:TAMEKA
Middle Name:MICHELLE
Last Name:BROUSSARD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:ATTN: MARIE SANCHEZ
Mailing Address - Street 2:6720 BERTNER AVE., SUITE O-520, MC1-226 , HARRIS COUNTY
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:832-355-6279
Mailing Address - Fax:832-355-6500
Practice Address - Street 1:7200 CAMBRIDGE STREET
Practice Address - Street 2:10TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4202
Practice Address - Country:US
Practice Address - Phone:713-798-1750
Practice Address - Fax:713-798-4693
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXBP10025537207L00000X
TXN4962207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2174177Medicaid
TXP00888496OtherRAILROAD MEDICARE
TX215541801Medicaid
TX8CL589OtherBLUE CROSS BLUE SHIELD
TX215541801Medicaid