MEDICARE: DR. KALU IREM OGBONNAYA M.D., P.A.

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	207R00000X	Internal Medicine Physician	G7415	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396737730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KALU IREM OGBONNAYA M.D., P.A.

Provider Business Mailing Address
First Line	:	9888 BISSONNET ST
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77036-8247
Country	:	US
Telephone Number	:	713-272-3780
Fax Number	:	713-272-3748

Provider Business Practice Location Address
First Line	:	9888 BISSONNET ST
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77036-8247
Country	:	US
Telephone Number	:	713-272-3780
Fax Number	:	713-272-3748

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/08/2007

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