Provider Demographics
NPI:1336906346
Name:COSTUS MEDICAL INC
Entity type:Organization
Organization Name:COSTUS MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:YEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADESOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-645-4156
Mailing Address - Street 1:2710 FM 1092 RD STE E
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5641
Mailing Address - Country:US
Mailing Address - Phone:832-645-4156
Mailing Address - Fax:832-645-5146
Practice Address - Street 1:2710 FM 1092 RD STE E
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5641
Practice Address - Country:US
Practice Address - Phone:832-645-4156
Practice Address - Fax:832-645-5146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty