Provider Demographics
NPI:1356457634
Name:EKHAESE, OBONORUMA (DO)
Entity Type:Individual
Prefix:
First Name:OBONORUMA
Middle Name:
Last Name:EKHAESE
Suffix:
Gender:M
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:PO BOX 891392
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77289-1392
Mailing Address - Country:US
Mailing Address - Phone:832-915-8140
Mailing Address - Fax:832-201-9181
Practice Address - Street 1:10905 MEMORIAL HERMANN DR STE 211
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:832-915-8140
Practice Address - Fax:832-201-9181
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9994208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK21299Medicare PIN