Provider Demographics
NPI:1346516218
Name:WILLIAMS, TEJUMADE KEHINDE (DO)
Entity Type:Individual
Prefix:
First Name:TEJUMADE
Middle Name:KEHINDE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7670 WOODWAY DR STE 165
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1594
Mailing Address - Country:US
Mailing Address - Phone:909-800-6205
Mailing Address - Fax:833-597-7555
Practice Address - Street 1:7670 WOODWAY DR STE 165
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1594
Practice Address - Country:US
Practice Address - Phone:909-800-6205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
TXP9768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program