Provider Demographics
NPI:1780823054
Name:HEALTHCARE LIAISON PROFESSIONALS, INC
Entity Type:Organization
Organization Name:HEALTHCARE LIAISON PROFESSIONALS, INC
Other - Org Name:US PHYSICIAN HOME VISITS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NOBLE
Authorized Official - Middle Name:
Authorized Official - Last Name:EZUKANMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:469-595-4730
Mailing Address - Street 1:1513 VICEROY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-2303
Mailing Address - Country:US
Mailing Address - Phone:214-244-9114
Mailing Address - Fax:
Practice Address - Street 1:1513 VICEROY DR
Practice Address - Street 2:SUITE
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2303
Practice Address - Country:US
Practice Address - Phone:214-244-9114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization