Provider Demographics
NPI:1013031095
Name:OBIORA M EKWEANI MD, PA
Entity Type:Organization
Organization Name:OBIORA M EKWEANI MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OBIORA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EKWEANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-668-3990
Mailing Address - Street 1:3220 PARKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-668-3990
Mailing Address - Fax:972-668-3991
Practice Address - Street 1:3220 PARKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034
Practice Address - Country:US
Practice Address - Phone:972-668-3990
Practice Address - Fax:972-668-3991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9522261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164983201Medicaid
TXK9522OtherTEXAS MEDICAL LICENSE #
TX00462WOtherMEDICARE
TX127521620Medicaid
MS14985OtherMEDICAL LICENSE #
1780670315OtherNPI
TXK9522OtherTEXAS MEDICAL LICENSE #
TX8B7569Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
110000893Medicare ID - Type Unspecified
TX00462WOtherMEDICARE
TX164983201Medicaid