MEDICARE: EVELYN ANNE ATIENO ODAWO 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	207R00000X	Internal Medicine Physician	S8353	TX

General Provider Information

NPI Number	:	1497001549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVELYN ANNE ATIENO ODAWO M.D

Provider Business Mailing Address
First Line	:	8121 BROADWAY ST STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-1342
Country	:	US
Telephone Number	:	832-709-2770
Fax Number	:	832-924-0113

Provider Business Practice Location Address
First Line	:	8121 BROADWAY ST STE 150
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77061-1342
Country	:	US
Telephone Number	:	832-709-2770
Fax Number	:	832-924-0113

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

Provider Enumeration Date	:	07/26/2012
Last Update Date	:	03/03/2021

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