Healthcare Provider Details

I. General information

NPI: 1477746840
Provider Name (Legal Business Name): OBIORA FRANK ANUSIONWU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 N GALLOWAY AVE STE 201
MESQUITE TX
75150-1125
US

IV. Provider business mailing address

6705 HERITAGE PKWY STE 202
ROCKWALL TX
75087-8727
US

V. Phone/Fax

Practice location:
  • Phone: 469-800-3200
  • Fax: 469-800-3210
Mailing address:
  • Phone: 469-800-3200
  • Fax: 469-800-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number216504
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberR4360
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number216504
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberR4360
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: