Provider Demographics
NPI:1629039938
Name:ENI, IKEDINOBI UGOCHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:IKEDINOBI
Middle Name:UGOCHUKWU
Last Name:ENI
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 1:17198 ST LUKES WAY STE 530
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-8016
Mailing Address - Country:US
Mailing Address - Phone:936-321-1946
Mailing Address - Fax:936-273-5774
Practice Address - Street 1:17198 ST LUKES WAY STE 530
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-8016
Practice Address - Country:US
Practice Address - Phone:936-321-1946
Practice Address - Fax:936-273-5774
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6843207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156623402Medicaid
TX00611UMedicare ID - Type Unspecified
TXG84955Medicare UPIN