Provider Demographics
NPI:1962503243
Name:KRUSLESKI, DAVID WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:KRUSLESKI
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 1:800 W SAM HOUSTON PKWY S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-1908
Mailing Address - Country:US
Mailing Address - Phone:713-462-6565
Mailing Address - Fax:832-831-5369
Practice Address - Street 1:19333 CLAY RD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4001
Practice Address - Country:US
Practice Address - Phone:713-462-6565
Practice Address - Fax:281-717-4456
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX118744502Medicaid
TX118744502Medicaid
E91001Medicare UPIN