Provider Demographics
NPI:1417060724
Name:SACKEY, EMMANUEL EDMUND (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:EDMUND
Last Name:SACKEY
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:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75120-0723
Mailing Address - Country:US
Mailing Address - Phone:972-875-5220
Mailing Address - Fax:972-875-5606
Practice Address - Street 1:601 S CLAY ST STE 101
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5771
Practice Address - Country:US
Practice Address - Phone:972-875-5220
Practice Address - Fax:972-875-5606
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4222208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF95631Medicare UPIN