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1659650091

NPI Code Detail

MEDICARE: DR. CHUKWUMA SOYINKA OSIFESO MD

MEDICARE: DR. CHUKWUMA SOYINKA OSIFESO MD

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	35-122832	OH
2	207R00000X	Internal Medicine Physician	57.019023	OH
3	207RN0300X	Nephrology Physician	T3354	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

General Provider Information

NPI Number	:	1659650091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHUKWUMA SOYINKA OSIFESO MD

Provider Business Mailing Address
First Line	:	1133 MEDICAL DR
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-2130
Country	:	US
Telephone Number	:	903-595-5486
Fax Number	:	903-595-5128

Provider Business Practice Location Address
First Line	:	9900 N CENTRAL EXPY STE 215
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-0929
Country	:	US
Telephone Number	:	214-396-4950
Fax Number	:

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

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	07/07/2022

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Directions to “ DR. CHUKWUMA SOYINKA OSIFESO MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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