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General NPI Number Information
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NPI Number | 1104490192
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Entity Type | Individual
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Provider Name | TAWANDA STEPHEN KAMUCHEKA MD
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Gender | Male
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Dates
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Enumeration Date | 05/14/2021
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 16620 N US HIGHWAY 281 STE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78232-2679
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Country | US
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Telephone | 210-871-4701
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Fax | 210-703-9155
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Provider Business Mailing Address
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Address Line | 16220 N US HWY 281 SUITE 300
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3585
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Country | US
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Telephone | 210-871-4701
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Fax | 210-688-4596
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | U3264
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | U3264
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | U3264
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License Number State | TX
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