Provider Demographics
NPI:1508069121
Name:EZUKANMA GROUP OF COMPANIES INC
Entity Type:Organization
Organization Name:EZUKANMA GROUP OF COMPANIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZUKANMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-882-9901
Mailing Address - Street 1:117 KING RANCH CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-9593
Mailing Address - Country:US
Mailing Address - Phone:817-882-9901
Mailing Address - Fax:817-882-8135
Practice Address - Street 1:508 S ADAMS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2147
Practice Address - Country:US
Practice Address - Phone:817-882-9901
Practice Address - Fax:817-882-8135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8745207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID NUMBER