Provider Demographics
NPI:1265809768
Name:UZOCHUKWU, IKENNA SAMUEL (NP)
Entity type:Individual
Prefix:
First Name:IKENNA
Middle Name:SAMUEL
Last Name:UZOCHUKWU
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2931 LAKE SHORE HARBOUR DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-7623
Mailing Address - Country:US
Mailing Address - Phone:917-204-1954
Mailing Address - Fax:
Practice Address - Street 1:3604 BUDDY OWENS AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5201
Practice Address - Country:US
Practice Address - Phone:956-213-8494
Practice Address - Fax:956-213-8492
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6377261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care