Healthcare Provider Details

I. General information

NPI: 1174152086
Provider Name (Legal Business Name): OKECHUKWU ONUMA OKIDI MBBS, FWACS, FICS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 FANNIN ST
HOUSTON TX
77030-2717
US

IV. Provider business mailing address

6550 FANNIN ST DEPT OF
HOUSTON TX
77030-2717
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-6172
  • Fax: 713-790-6470
Mailing address:
  • Phone: 713-441-6172
  • Fax: 713-790-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: