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General NPI Number Information
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NPI Number | 1730618620
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Entity Type | Organization
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Legal Business Name | TEXAS BENEVOLENTCARE LLC
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 06/06/2017
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Provider Practice Location Address
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Address Line | 8380 WARREN PKWY STE 602
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City | FRISCO
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State | TX
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Zip | 75034-4253
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Country | US
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Telephone | 917-860-8198
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 940194
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City | PLANO
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State | TX
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Zip | 75094-0194
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Country | US
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Telephone | 917-860-8198
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | IFEANYI IZEDIUNO
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Credential | MD
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Telephone | 917-860-8198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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