Provider Demographics
NPI:1962750463
Name:ABDEL K. FUSTOK, MD PA
Entity type:Organization
Organization Name:ABDEL K. FUSTOK, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABDEL
Authorized Official - Middle Name:KADER
Authorized Official - Last Name:FUSTOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-621-2950
Mailing Address - Street 1:4140 SOUTHWEST FWY STE 510
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7319
Mailing Address - Country:US
Mailing Address - Phone:713-621-2950
Mailing Address - Fax:713-621-2139
Practice Address - Street 1:4140 SOUTHWEST FWY STE 510
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7319
Practice Address - Country:US
Practice Address - Phone:713-621-2950
Practice Address - Fax:713-621-2139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4727174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty