=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013031095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OBIORA M EKWEANI MD, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2007
-----------------------------------------------------
Last Update Date | 03/15/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3220 PARKWOOD BLVD
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-668-3990
-----------------------------------------------------
Fax | 972-668-3991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3220 PARKWOOD BLVD
-----------------------------------------------------
City | FRISCO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-668-3990
-----------------------------------------------------
Fax | 972-668-3991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. OBIORA M EKWEANI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 972-668-3990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | K9522
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------