Provider Demographics
NPI:1407994056
Name:IKECHUKWU OSUJI, M.D PA
Entity Type:Organization
Organization Name:IKECHUKWU OSUJI, M.D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TOCHI
Authorized Official - Middle Name:A
Authorized Official - Last Name:OSUJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-230-8881
Mailing Address - Street 1:1110 E. PLEASANT RUN ROAD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115
Mailing Address - Country:US
Mailing Address - Phone:972-230-8881
Mailing Address - Fax:972-230-8810
Practice Address - Street 1:1110 E. PLEASANT RUN ROAD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115
Practice Address - Country:US
Practice Address - Phone:972-230-8881
Practice Address - Fax:972-230-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6669261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0076QJOtherBLUE CROSS BLUE SHIELD
TX122225912Medicaid
TX165471701Medicaid
TX122225912Medicaid
TX00863VMedicare PIN