Provider Demographics
NPI:1285026963
Name:IJEOMA NNAMANI MD PA
Entity Type:Organization
Organization Name:IJEOMA NNAMANI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:NNAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-513-2421
Mailing Address - Street 1:350 WESTPARK WAY
Mailing Address - Street 2:STE 123
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3964
Mailing Address - Country:US
Mailing Address - Phone:817-267-3065
Mailing Address - Fax:817-545-9097
Practice Address - Street 1:350 WESTPARK WAY
Practice Address - Street 2:STE 123
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3964
Practice Address - Country:US
Practice Address - Phone:817-267-3065
Practice Address - Fax:817-545-9097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty