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General NPI Number Information
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NPI Number | 1174397988
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Entity Type | Individual
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Provider Name | COSMAS ONYEDIKA IHEZIE MD, CSFA
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Gender | Male
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Dates
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Enumeration Date | 11/13/2023
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER 11937 U.S. HWY. 271
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City | TYLER
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State | TX
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Zip | 75708-4603
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Country | US
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Telephone | 903-877-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 564 LAKE FOREST DR
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City | COPPELL
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State | TX
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Zip | 75019-2826
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Country | US
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Telephone | 469-237-5072
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Fax |
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | TX
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