Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | Q9574 | TX |
NPI | 1003220625 |
---|---|
Provider Name | Kelechi Azuogu |
First Address | Missouri City, TX 77459-5055 |
Second Address | Houston, TX 77074-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 17/03/2018 |