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General NPI Number Information
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NPI Number | 1265336127
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Entity Type | Organization
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Legal Business Name | PULCREX MEDICAL GROUP
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 6262 E BROADWAY RD STE 106
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City | MESA
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State | AZ
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Zip | 85206-6101
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Country | US
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Telephone | 832-267-8165
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Fax |
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Provider Business Mailing Address
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Address Line | 6262 E BROADWAY RD STE 106
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City | MESA
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State | AZ
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Zip | 85206-6101
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Country | US
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Telephone | 832-267-8165
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. CHIKAODI BANOR
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Credential | DNP
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Telephone | 713-355-0426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State | NULL
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