MEDICARE: OLUCHI IBEKWE IMMANUEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	Q1174	TX

General Provider Information

NPI Number	:	1275889347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLUCHI IBEKWE IMMANUEL MD

Provider Business Mailing Address
First Line	:	5680 HIGHWAY 6 STE 225
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-4188
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6671 SOUTHWEST FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2212
Country	:	US
Telephone Number	:	713-773-2820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	04/13/2023

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