Healthcare Provider Details

I. General information

NPI: 1346734258
Provider Name (Legal Business Name): BAYOUCITY PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8727 W RAYFORD RD STE 160
SPRING TX
77389-5440
US

IV. Provider business mailing address

8727 W RAYFORD RD STE 160
SPRING TX
77389-5440
US

V. Phone/Fax

Practice location:
  • Phone: 281-547-8880
  • Fax: 772-264-0600
Mailing address:
  • Phone: 281-547-8880
  • Fax: 772-264-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ISMAIL ADESANYA
Title or Position: CO-MEDICAL DIRECTOR
Credential: MD
Phone: 281-547-8880