Healthcare Provider Details

I. General information

NPI: 1174788178
Provider Name (Legal Business Name): ENYINNAYA UGOCHUKWU ABARIKWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DAWSON ST
TYLER TX
75701-2036
US

IV. Provider business mailing address

W3985 COUNTY ROAD NN
ELKHORN WI
53121-4337
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-7264
  • Fax: 903-525-1254
Mailing address:
  • Phone: 262-741-2000
  • Fax: 262-741-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP5317
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number68252
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP5317
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: