MEDICARE: MARIO OSVALDO KAPUSTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	11435	OK
2	174400000X	Specialist	F0537	TX
3	174400000X	Specialist	C42419	CA
4	2086S0129X	Vascular Surgery Physician	F0537	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060049733	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4076907	OTHER	TX	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8M0430	OTHER	TX	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1437268943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO OSVALDO KAPUSTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6730
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77265-6730
Country	:	US
Telephone Number	:	713-349-8346
Fax Number	:	713-218-8346

Provider Business Practice Location Address
First Line	:	5585 WESLAYAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1941
Country	:	US
Telephone Number	:	713-349-8346
Fax Number	:	713-218-8346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	03/07/2022

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Directions to “ MARIO OSVALDO KAPUSTA M.D.” Practice Location

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