Provider Demographics
NPI:1629270590
Name:PAUL MICHAEL & ANGELA AKONYE
Entity Type:Organization
Organization Name:PAUL MICHAEL & ANGELA AKONYE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-260-5509
Mailing Address - Street 1:12859 HUNTING ARROW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-4341
Mailing Address - Country:US
Mailing Address - Phone:210-260-5509
Mailing Address - Fax:210-375-3194
Practice Address - Street 1:12859 HUNTING ARROW
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-4341
Practice Address - Country:US
Practice Address - Phone:210-260-5509
Practice Address - Fax:210-375-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization