MEDICARE: DR. IFEOMA N ARENE 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	2084P0800X	Psychiatry Physician	L5229	TX
2	2084P0804X	Child & Adolescent Psychiatry Physician	L5229	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	312658605	OTHER	TX	UNITED BEHAVIORAL HEALTH
3	01161084	OTHER	TX	AMERIGROUP

General Provider Information

NPI Number	:	1780642488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFEOMA N ARENE MD

Provider Business Mailing Address
First Line	:	12828 WILLOW CTR
Second Line	:	SUITE E
City	:	HOUSTON
State	:	TX
Zip	:	77066-3043
Country	:	US
Telephone Number	:	281-893-3656
Fax Number	:	281-893-3464

Provider Business Practice Location Address
First Line	:	12828 WILLOW CTR
Second Line	:	SUITE E
City	:	HOUSTON
State	:	TX
Zip	:	77066-3043
Country	:	US
Telephone Number	:	281-893-3656
Fax Number	:	281-893-3464

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	06/02/2010

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