Healthcare Provider Details

I. General information

NPI: 1760600738
Provider Name (Legal Business Name): KUDAKWASHE R. CHIKWAVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

IV. Provider business mailing address

6621 FANNIN ST
HOUSTON TX
77030-2399
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-8292
  • Fax:
Mailing address:
  • Phone: 832-824-8292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberU3186
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: