MEDICARE: DR. VICTOR AKHIDENOR PH.D

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1831793389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR AKHIDENOR PH.D

Provider Business Mailing Address
First Line	:	8124 MODESTO DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-8545
Country	:	US
Telephone Number	:	281-989-8293
Fax Number	:	682-222-7277

Provider Business Practice Location Address
First Line	:	8124 MODESTO DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76001-8545
Country	:	US
Telephone Number	:	281-989-8293
Fax Number	:	682-222-7277

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

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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