MEDICARE: MAXIMUS NWAKALUNNA ANITUBE M.D.

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	MT198408	PA
2	2084P0800X	Psychiatry Physician	P5024	TX

General Provider Information

NPI Number	:	1316250483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAXIMUS NWAKALUNNA ANITUBE M.D.

Provider Business Mailing Address
First Line	:	1704 LISBURN DR
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-3348
Country	:	US
Telephone Number	:	617-838-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	4817 MEDICAL CENTER DR STE 3A
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75069-1886
Country	:	US
Telephone Number	:	972-607-9650
Fax Number	:

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

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	10/07/2020

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