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General NPI Number Information
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NPI Number | 1326913906
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Entity Type | Individual
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Provider Name | MR. OSAZE IDUMWONYI
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Gender | Male
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 11/09/2025
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Provider Practice Location Address
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Address Line | 8500 N STEMMONS FWY STE 1090
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City | DALLAS
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State | TX
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Zip | 75247-3848
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Country | US
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Telephone | 972-740-6059
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 667
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City | CEDAR HILL
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State | TX
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Zip | 75106-0667
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Country | US
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Telephone |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 20140
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License Number State | TX
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