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General NPI Number Information
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NPI Number | 1902422785
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Entity Type | Organization
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Legal Business Name | MICABY MEDICAL,PLLC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 10730 POTRANCO RD STE 122-507
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City | SAN ANTONIO
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State | TX
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Zip | 78251-3327
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Country | US
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Telephone | 210-858-7604
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Fax | 210-888-0383
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Provider Business Mailing Address
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Address Line | 1222 MCCULLOUGH AVE STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4812
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Country | US
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Telephone | 210-858-7604
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Fax | 210-888-0383
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEZEKIAH OLUWAROTIMI SOBAMOWO
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Credential | MD
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Telephone | 615-397-0896
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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