Provider Demographics
NPI:1467469981
Name:CHIDOKA, SAMUEL CHUKWUDI (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CHUKWUDI
Last Name:CHIDOKA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 WESTWICK
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082
Mailing Address - Country:US
Mailing Address - Phone:281-770-1279
Mailing Address - Fax:713-243-8759
Practice Address - Street 1:11200 WESTHEIMER
Practice Address - Street 2:953
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042
Practice Address - Country:US
Practice Address - Phone:713-243-8728
Practice Address - Fax:713-243-8759
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03684363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
677869Medicare ID - Type Unspecified