Basic Information
| Provider Information | |||||||||
| NPI: | 1780928226 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COSMOPOLITAN SURGICAL, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16651 SOUTHWEST FREEWAY, #370 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815651009 | ||||||||
| FaxNumber: | 8322010901 | ||||||||
| Practice Location | |||||||||
| Address1: | 17510 WEST GRAND PARKWAY, SUITE 200 | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812381600 | ||||||||
| FaxNumber: | 2812381650 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2012 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | GAJULA | ||||||||
| AuthorizedOfficialFirstName: | LEKA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2815651009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 367500000X | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.