Provider Demographics
NPI:1033110929
Name:CZELUSTA, ADAM J (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:CZELUSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21310 PROVINCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-7580
Mailing Address - Country:US
Mailing Address - Phone:281-599-0404
Mailing Address - Fax:281-599-1655
Practice Address - Street 1:21310 PROVINCIAL BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-7580
Practice Address - Country:US
Practice Address - Phone:281-599-0404
Practice Address - Fax:281-599-1655
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5711207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4325669OtherCIGNA
TX7039471OtherAETNA
TX8M9030OtherBCBS
TX159655302Medicaid
TX8C0289Medicare ID - Type Unspecified
TX7039471OtherAETNA
TX8M9030OtherBCBS