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General NPI Number Information
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NPI Number | 1508069121
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Entity Type | Organization
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Legal Business Name | EZUKANMA GROUP OF COMPANIES INC
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Dates
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Enumeration Date | 06/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 508 S ADAMS ST SUITE 100
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City | FORT WORTH
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State | TX
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Zip | 76104-2147
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Country | US
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Telephone | 817-882-9901
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Fax | 817-882-8135
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Provider Business Mailing Address
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Address Line | 117 KING RANCH CT
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City | FORT WORTH
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State | TX
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Zip | 76108-9593
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Country | US
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Telephone | 817-882-9901
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Fax | 817-882-8135
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Authorized Official
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Title or Position | PRESIDENT
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Name | NOBLE EZUKANMA
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Credential | M.D.
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Telephone | 817-882-9901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | K8745
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License Number State | TX
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