Healthcare Provider Details

I. General information

NPI: 1124524525
Provider Name (Legal Business Name): EBONEE CHINYERE DIKAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16605 SOUTHWEST FWY STE 175
SUGAR LAND TX
77479-0003
US

IV. Provider business mailing address

16003 GRAFTONDALE CT
HOUSTON TX
77084-7571
US

V. Phone/Fax

Practice location:
  • Phone: 281-666-8065
  • Fax:
Mailing address:
  • Phone: 832-863-5984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT6550
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: