Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 28579 | TX |
NPI | 1235298597 |
---|---|
Provider Name | Kalu Ugwa Ogbureke |
First Address | Houston, TX 77054-2032 |
Second Address | Houston, TX 77054-2032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1418385 | UNITED CONCORDIA (01) | GA |
22BDFBT | MEDICARE (01) | GA |
586469939A | (05) | GA |
ZG0326 | (05) | SC |