MEDICARE: MR. EMMANUEL N/A OHERI N/A

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	:	1881954790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EMMANUEL N/A OHERI N/A

Provider Business Mailing Address
First Line	:	12731 CORONA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-4605
Country	:	US
Telephone Number	:	832-955-5983
Fax Number	:

Provider Business Practice Location Address
First Line	:	12731 CORONA LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-4605
Country	:	US
Telephone Number	:	832-955-5983
Fax Number	:

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

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	05/24/2012

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