Healthcare Provider Details

I. General information

NPI: 1386805919
Provider Name (Legal Business Name): NDIDI UFONDU DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS NDIDI UKA

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 OSLER DR STE 150
ARLINGTON TX
76010-5407
US

IV. Provider business mailing address

PO BOX 210773
BEDFORD TX
76095-7773
US

V. Phone/Fax

Practice location:
  • Phone: 817-538-5291
  • Fax: 682-238-0738
Mailing address:
  • Phone: 817-330-9698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00296800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number3008
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number3008
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00296800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: