Provider Demographics
NPI:1083654438
Name:UNINI, FIDELIS KANAYO (MD)
Entity Type:Individual
Prefix:DR
First Name:FIDELIS
Middle Name:KANAYO
Last Name:UNINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 HEMPHILL ST.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4137
Mailing Address - Country:US
Mailing Address - Phone:817-923-8484
Mailing Address - Fax:817-923-8494
Practice Address - Street 1:609 HEMPHILL ST.
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4137
Practice Address - Country:US
Practice Address - Phone:817-923-8484
Practice Address - Fax:817-923-8494
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239922207R00000X
TXM5959207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2591789OtherGROUP HEALTH INCORP.
00092354001OtherHEALTHNOW
118542BJOtherPREFERRED CARE
7116498OtherAETNA
P01001955OtherEXCELLUS
P01001955OtherBLUE SHIELD
NY02496142Medicaid
P01001955OtherEXCELLUS
2591789OtherGROUP HEALTH INCORP.