MEDICARE: OBONORUMA I EKHAESE

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	208600000X	Surgery Physician	M9994	TX

General Provider Information

NPI Number	:	1578703179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBONORUMA I EKHAESE

Provider Business Mailing Address
First Line	:	PO BOX 891392
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77289-1392
Country	:	US
Telephone Number	:	832-915-8140
Fax Number	:

Provider Business Practice Location Address
First Line	:	10907 MEMORIAL HERMANN DR STE 440
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-4114
Country	:	US
Telephone Number	:	832-915-8140
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OBONORUMA IMARIABE EKHAESE
Credential	:	D.O
Telephone Number	:	713-562-2691

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	05/08/2024

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Directions to “OBONORUMA I EKHAESE ” Practice Location

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