MEDICARE: MR. OSAZE IDUMWONYI

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	172V00000X	Community Health Worker	20140	TX

General Provider Information

NPI Number	:	1326913906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OSAZE IDUMWONYI

Provider Business Mailing Address
First Line	:	PO BOX 667
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75106-0667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8500 N STEMMONS FWY STE 1090
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-3848
Country	:	US
Telephone Number	:	972-740-6059
Fax Number	:

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

Provider Enumeration Date	:	10/06/2025
Last Update Date	:	01/22/2026

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Directions to “ MR. OSAZE IDUMWONYI ” Practice Location

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