Healthcare Provider Details

I. General information

NPI: 1104489681
Provider Name (Legal Business Name): FORTUNE CHIMDINDU UNEGBU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 HERO WAY STE 100
LEANDER TX
78641-5579
US

IV. Provider business mailing address

PO BOX 10597
AUSTIN TX
78766-1597
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-2273
  • Fax: 512-862-4739
Mailing address:
  • Phone: 512-420-0186
  • Fax: 903-200-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberV7092
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: