=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174788178
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ENYINNAYA UGOCHUKWU ABARIKWU MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2008
-----------------------------------------------------
Last Update Date | 09/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 E DAWSON ST
-----------------------------------------------------
City | TYLER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75701-2036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-606-7264
-----------------------------------------------------
Fax | 903-525-1254
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | W3985 COUNTY ROAD NN
-----------------------------------------------------
City | ELKHORN
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53121-4337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-741-2000
-----------------------------------------------------
Fax | 262-741-2199
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | P5317
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 68252
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | P5317
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------