MEDICARE: DR. ATABONG AWUNG MBELEM MD, RN

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	163W00000X	Registered Nurse	R175863	MD

General Provider Information

NPI Number	:	1780310979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATABONG AWUNG MBELEM MD, RN

Provider Business Mailing Address
First Line	:	4002 ORCHARD PARK LN
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-2667
Country	:	US
Telephone Number	:	475-692-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 ORCHARD PARK LN
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-2667
Country	:	US
Telephone Number	:	647-569-2376
Fax Number	:

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

Provider Enumeration Date	:	07/28/2022
Last Update Date	:	07/28/2022

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