Healthcare Provider Details

I. General information

NPI: 1902070766
Provider Name (Legal Business Name): ABRAHAM CHUKWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 REGENCY PKY SUITE 105
MANSFIELD TX
76063
US

IV. Provider business mailing address

3901 ARLINGTON HIGHLANDS BLVD STE 200
ARLINGTON TX
76018-6050
US

V. Phone/Fax

Practice location:
  • Phone: 800-859-3119
  • Fax: 866-561-4044
Mailing address:
  • Phone: 800-859-3119
  • Fax: 866-695-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberP3868
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: