Provider Demographics
NPI:1407286859
Name:UMOH, IKANEDEM
Entity Type:Individual
Prefix:
First Name:IKANEDEM
Middle Name:
Last Name:UMOH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 HARWIN DR
Mailing Address - Street 2:538
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1545
Mailing Address - Country:US
Mailing Address - Phone:281-888-4637
Mailing Address - Fax:281-888-6256
Practice Address - Street 1:10333 HARWIN DR
Practice Address - Street 2:538
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1545
Practice Address - Country:US
Practice Address - Phone:281-888-4637
Practice Address - Fax:281-888-6256
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0106049332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195983501Medicaid