Provider Demographics
NPI:1649470253
Name:KALU I OGBONNAYA, M.D., P.A..
Entity type:Organization
Organization Name:KALU I OGBONNAYA, M.D., P.A..
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-628-3033
Mailing Address - Street 1:9888 BISSONNET ST STE 160
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8039
Mailing Address - Country:US
Mailing Address - Phone:713-272-3780
Mailing Address - Fax:
Practice Address - Street 1:9888 BISSONNET ST STE 160
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8039
Practice Address - Country:US
Practice Address - Phone:713-272-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-21
Last Update Date:2007-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB25238Medicare UPIN
TX8996B9Medicare PIN
TX00220UMedicare PIN