MEDICARE: JENNIFER ERINMA UDEOGU 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	208000000X	Pediatrics Physician	V8421	TX
2	208000000X	Pediatrics Physician	85087-20	WI

General Provider Information

NPI Number	:	1962155077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ERINMA UDEOGU MD

Provider Business Mailing Address
First Line	:	6621 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2358
Country	:	US
Telephone Number	:	612-626-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	6621A FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2303
Country	:	US
Telephone Number	:	832-824-1000
Fax Number	:

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

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	01/15/2026

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