=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629270590
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAUL MICHAEL & ANGELA AKONYE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12859 HUNTING ARROW
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-260-5509
-----------------------------------------------------
Fax | 210-375-3194
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12859 HUNTING ARROW
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78249-4341
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-260-5509
-----------------------------------------------------
Fax | 210-375-3194
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. PAUL MICHAEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 210-260-5509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------