Healthcare Provider Details

I. General information

NPI: 1962503243
Provider Name (Legal Business Name): DAVID WAYNE KRUSLESKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19333 CLAY RD
KATY TX
77449-4001
US

IV. Provider business mailing address

800 W SAM HOUSTON PKWY S SUITE 200
HOUSTON TX
77042-1908
US

V. Phone/Fax

Practice location:
  • Phone: 713-462-6565
  • Fax: 281-717-4456
Mailing address:
  • Phone: 713-462-6565
  • Fax: 832-831-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ0052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: