Provider Demographics
NPI:1467409078
Name:OSUJI, IKECHUKWU A (MD)
Entity Type:Individual
Prefix:DR
First Name:IKECHUKWU
Middle Name:A
Last Name:OSUJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:75115-7401
Mailing Address - Country:US
Mailing Address - Phone:214-454-3637
Mailing Address - Fax:972-230-8810
Practice Address - Street 1:1110 E PLEASANT RUN RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4202
Practice Address - Country:US
Practice Address - Phone:972-230-8881
Practice Address - Fax:972-230-8810
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122225912Medicaid
TX8B2521Medicare PIN