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General NPI Number Information
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NPI Number | 1326453465
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Entity Type | Individual
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Provider Name | CEISHA UKATU M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2014
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 12001 SOUTH FWY STE 209
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City | BURLESON
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State | TX
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Zip | 76028-7214
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Country | US
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Telephone | 682-385-7010
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Fax | 682-385-7011
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Provider Business Mailing Address
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Address Line | PO BOX 6278
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City | FORT WORTH
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State | TX
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Zip | 76115-0278
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Country | US
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Telephone | 682-385-7010
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Fax | 682-385-7011
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 2014021212
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 036.166777
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | R9879
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License Number State | TX
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