Provider Demographics
NPI:1780310979
Name:MBELEM, ATABONG AWUNG (MD, RN)
Entity type:Individual
Prefix:DR
First Name:ATABONG
Middle Name:AWUNG
Last Name:MBELEM
Suffix:
Gender:M
Credentials:MD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 ORCHARD PARK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-2667
Mailing Address - Country:US
Mailing Address - Phone:475-692-3766
Mailing Address - Fax:
Practice Address - Street 1:4002 ORCHARD PARK LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-2667
Practice Address - Country:US
Practice Address - Phone:647-569-2376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175863163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty