Provider Demographics
NPI:1376680348
Name:EGBUNIKE, AUGUSTINE O (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTINE
Middle Name:O
Last Name:EGBUNIKE
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 1:7111 HARWIN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2129
Mailing Address - Country:US
Mailing Address - Phone:713-914-0055
Mailing Address - Fax:713-914-0077
Practice Address - Street 1:7111 HARWIN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2129
Practice Address - Country:US
Practice Address - Phone:713-914-0055
Practice Address - Fax:713-914-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137301107Medicaid
TXF91887Medicare UPIN
TX0006AGMedicare PIN