Provider Demographics
NPI:1891996112
Name:ANAMEKWE, KENECHIM A (MD)
Entity Type:Individual
Prefix:DR
First Name:KENECHIM
Middle Name:A
Last Name:ANAMEKWE
Suffix:
Gender:F
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:PO BOX 1119
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1119
Mailing Address - Country:US
Mailing Address - Phone:972-941-8484
Mailing Address - Fax:
Practice Address - Street 1:500 S WESTGATE WAY
Practice Address - Street 2:SUITE #300
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5308
Practice Address - Country:US
Practice Address - Phone:972-941-8484
Practice Address - Fax:972-941-8480
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX217539003Medicaid
TX8CN503OtherBCBS
TX217539002Medicaid
TXTXB114738Medicare PIN
TX217539001Medicaid