Provider Demographics
NPI:1649571415
Name:KELAJI, EBENEZER S
Entity Type:Individual
Prefix:MR
First Name:EBENEZER
Middle Name:S
Last Name:KELAJI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 218A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7497
Mailing Address - Country:US
Mailing Address - Phone:713-774-1158
Mailing Address - Fax:713-774-1169
Practice Address - Street 1:8700 COMMERCE PARK DR
Practice Address - Street 2:SUITE 218A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7497
Practice Address - Country:US
Practice Address - Phone:713-774-1158
Practice Address - Fax:713-774-1169
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6453360001Medicare NSC