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1104845304

NPI Code Detail

MEDICARE: DR. IKECHUKWU ROBERT OFOMATA MD

MEDICARE: DR. IKECHUKWU ROBERT OFOMATA MD

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
1	2084P0800X	Psychiatry Physician	L5857	TX
2	2084P0805X	Geriatric Psychiatry Physician	L5857	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104845304
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IKECHUKWU ROBERT OFOMATA MD

Provider Business Mailing Address
First Line	:	2709 BITTERNUT DR
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75082-5208
Country	:	US
Telephone Number	:	214-330-0036
Fax Number	:	214-337-3905

Provider Business Practice Location Address
First Line	:	1350 N WESTMORELAND RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-1654
Country	:	US
Telephone Number	:	214-330-0036
Fax Number	:	214-337-3905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/08/2025

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Directions to “ DR. IKECHUKWU ROBERT OFOMATA MD” Practice Location

Language	Start Address	Practice Location

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