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NPI Code Detail

MEDICARE: DR. CHUKWUAGOZIE OBINNA ILOMA DO,MHA/INF

MEDICARE: DR. CHUKWUAGOZIE OBINNA ILOMA DO,MHA/INF
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
1207P00000XEmergency Medicine PhysicianS9316TX

General Provider Information

NPI Number : 1235699745
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHUKWUAGOZIE OBINNA ILOMA DO,MHA/INF
Provider Business Mailing Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4941
Country : US
Telephone Number : 817-702-8840
Fax Number :
Provider Business Practice Location Address
First Line : 1500 S MAIN ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76104-4941
Country : US
Telephone Number : 817-702-8840
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2019
Last Update Date : 06/09/2021

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