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General NPI Number Information
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NPI Number | 1023535457
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Entity Type | Organization
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Legal Business Name | AZOG PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 2525 NORTH LOOP W STE 408
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City | HOUSTON
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State | TX
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Zip | 77008-1027
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Country | US
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Telephone | 832-645-2467
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Fax |
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Provider Business Mailing Address
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Address Line | 6930 SABLE RIVER DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-5055
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Country | US
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Telephone | 832-443-2909
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | KELECHI AZUOGU
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Credential | MD
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Telephone | 832-443-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | Q9574
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License Number State | TX
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