Provider Demographics
NPI:1063253789
Name:NAMELESS MEDICINE PLLC
Entity type:Organization
Organization Name:NAMELESS MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVLEY
Authorized Official - Middle Name:MATHEWS
Authorized Official - Last Name:KOSHY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-206-0153
Mailing Address - Street 1:24770 STOWBRIDGE DR APT 6201
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-7584
Mailing Address - Country:US
Mailing Address - Phone:713-206-0153
Mailing Address - Fax:
Practice Address - Street 1:8450 WILL CLAYTON PKWY
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5830
Practice Address - Country:US
Practice Address - Phone:713-206-0153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty