Provider Demographics
NPI:1609817436
Name:CHILEK, JENNIFER L (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CHILEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19782 HIGHWAY 105 W
Mailing Address - Street 2:SUITE 111
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5632
Mailing Address - Country:US
Mailing Address - Phone:936-582-0220
Mailing Address - Fax:936-582-0222
Practice Address - Street 1:19782 HIGHWAY 105 W
Practice Address - Street 2:SUITE 111
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5632
Practice Address - Country:US
Practice Address - Phone:936-582-0220
Practice Address - Fax:936-582-0222
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8307207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I 10685Medicare UPIN
TX8C0886Medicare PIN