Healthcare Provider Details

I. General information

NPI: 1982711297
Provider Name (Legal Business Name): KWABENA OWUSU M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 TWELVE OAKS
HOUSTON TX
77027-6812
US

IV. Provider business mailing address

4803 N PINE BROOK WAY
HOUSTON TX
77059-3161
US

V. Phone/Fax

Practice location:
  • Phone: 713-964-8600
  • Fax: 713-622-8993
Mailing address:
  • Phone: 281-990-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberL2526
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: