Organization
KATY DERMATOLOGY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADAM J CZELUSTA M.D. (OWNER)
(281) 599-0404
Entity
Organization
Contact information
Practice address
21310 PROVINCIAL BLVD, KATY, TX 77450-7580
(281) 599-0404
(281) 599-1655
Mailing address
21310 PROVINCIAL BLVD, KATY, TX 77450-7580
(281) 599-0404
(281) 599-1655
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L5711
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074LM
BCBS
TX
05
—
168278301
—
TX
01
—
4516713
CIGNA
TX
Enumeration date
06/21/2007
Last updated
09/21/2010
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