Healthcare Provider Details

I. General information

NPI: 1396737730
Provider Name (Legal Business Name): KALU IREM OGBONNAYA M.D., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 BISSONNET ST SUITE 160
HOUSTON TX
77036-8247
US

IV. Provider business mailing address

9888 BISSONNET ST SUITE 160
HOUSTON TX
77036-8247
US

V. Phone/Fax

Practice location:
  • Phone: 713-272-3780
  • Fax: 713-272-3748
Mailing address:
  • Phone: 713-272-3780
  • Fax: 713-272-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG7415
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: