Provider Demographics
NPI:1477894764
Name:NDRI, KOUAME STEPHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KOUAME
Middle Name:STEPHANE
Last Name:NDRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STEPHANE
Other - Middle Name:KOUAME
Other - Last Name:NDRI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9101
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-9494
Mailing Address - Country:US
Mailing Address - Phone:972-745-7500
Mailing Address - Fax:972-471-0700
Practice Address - Street 1:779 GRAPEVINE HWY
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2805
Practice Address - Country:US
Practice Address - Phone:817-428-7300
Practice Address - Fax:817-428-1085
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10047109207Q00000X
TXQ7435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine