Provider Demographics
NPI:1235151192
Name:ENELI, KENECHUKWU O (MD)
Entity Type:Individual
Prefix:DR
First Name:KENECHUKWU
Middle Name:O
Last Name:ENELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 W CENTRAL TEXAS EXPY
Mailing Address - Street 2:125
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1899
Mailing Address - Country:US
Mailing Address - Phone:254-618-1050
Mailing Address - Fax:254-618-1058
Practice Address - Street 1:800 W CENTRAL TEXAS EXPY
Practice Address - Street 2:125
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1899
Practice Address - Country:US
Practice Address - Phone:254-618-1050
Practice Address - Fax:254-618-1058
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-107495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN4399OtherTEXAS MEDICAL BOARD
H68847Medicare UPIN
TX283786602Medicare PIN