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NPI Code Detail

MEDICARE: BENSON IGBOELI

MEDICARE: BENSON IGBOELI
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251T00000XPACE Provider Organization000000000000TX

General Provider Information

NPI Number : 1003161274
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENSON IGBOELI
Provider Business Mailing Address
First Line : 829 SPRINGWOOD DR
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-6092
Country : US
Telephone Number : 972-262-5828
Fax Number : 972-262-5828
Provider Business Practice Location Address
First Line : 829 SPRINGWOOD DR
Second Line :
City : GRAND PRAIRIE
State : TX
Zip : 75052-6092
Country : US
Telephone Number : 972-262-5828
Fax Number : 972-262-5828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2012
Last Update Date : 07/13/2012

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Directions to “ BENSON IGBOELI ” Practice Location

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