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General NPI Number Information
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NPI Number | 1861760506
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Entity Type | Organization
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Legal Business Name | IBIDUNNI O UKEGBU PA
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 8067 W VIRGINIA DR SUITE 101
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City | DALLAS
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State | TX
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Zip | 75237-3767
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Country | US
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Telephone | 469-453-2008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1598
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City | CEDAR HILL
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State | TX
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Zip | 75106-1598
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Country | US
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Telephone | 469-453-2008
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IBISUNNI O UKEGBU
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Credential | MD
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Telephone | 469-453-2008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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