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General NPI Number Information
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NPI Number | 1336906346
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Entity Type | Organization
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Legal Business Name | COSTUS MEDICAL INC
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Dates
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Enumeration Date | 03/05/2024
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 2710 FM 1092 RD STE E
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City | MISSOURI CITY
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State | TX
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Zip | 77459-5641
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Country | US
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Telephone | 832-645-4156
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Fax | 832-645-5146
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Provider Business Mailing Address
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Address Line | 2710 FM 1092 RD STE E
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City | MISSOURI CITY
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State | TX
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Zip | 77459-5641
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Country | US
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Telephone | 832-645-4156
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Fax | 832-645-5146
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Authorized Official
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Title or Position | ADMIN/MANAGING MEMBER
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Name | YEMI ADESOLA
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Credential |
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Telephone | 832-645-4156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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