Healthcare Provider Details

I. General information

NPI: 1972685253
Provider Name (Legal Business Name): TANIA IJEOMA IFEANYI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 POST OAK PLACE DR SUITE 130
HOUSTON TX
77027-3164
US

IV. Provider business mailing address

4545 POST OAK PLACE DR SUITE 130
HOUSTON TX
77027-3164
US

V. Phone/Fax

Practice location:
  • Phone: 713-960-8008
  • Fax: 713-960-0965
Mailing address:
  • Phone: 713-960-8008
  • Fax: 713-960-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM0204
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: