MEDICARE: ISICHEI SAMUEL ANENE

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	172A00000X	Driver

General Provider Information

NPI Number	:	1962036442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISICHEI SAMUEL ANENE

Provider Business Mailing Address
First Line	:	104 INDUSTRIAL BLVD STE D
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3170
Country	:	US
Telephone Number	:	907-351-4814
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 INDUSTRIAL BLVD STE D
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3170
Country	:	US
Telephone Number	:	907-351-4814
Fax Number	:

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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Directions to “ ISICHEI SAMUEL ANENE ” Practice Location

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