Healthcare Provider Details

I. General information

NPI: 1043997927
Provider Name (Legal Business Name): CHIMEREMEZE NDUBUOKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5323 HARRY HINES BLVD STOP 7200
DALLAS TX
75390-7200
US

IV. Provider business mailing address

5323 HARRY HINES BLVD STOP 7200
DALLAS TX
75390-7200
US

V. Phone/Fax

Practice location:
  • Phone: 214-648-3111
  • Fax:
Mailing address:
  • Phone: 214-456-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number53467
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: