Provider Demographics
NPI:1053756650
Name:KEITH FLAK MD PLLC
Entity type:Organization
Organization Name:KEITH FLAK MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:FLAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-292-3999
Mailing Address - Street 1:4747 RESEARCH FOREST DR
Mailing Address - Street 2:SUITE 180-206
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4912
Mailing Address - Country:US
Mailing Address - Phone:281-292-3999
Mailing Address - Fax:
Practice Address - Street 1:920 MEDICAL PLAZA DR STE 260
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3275
Practice Address - Country:US
Practice Address - Phone:281-292-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5054207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty