Provider Demographics
NPI:1821410523
Name:CHUKWUMA OSUAGWU MD PA
Entity type:Organization
Organization Name:CHUKWUMA OSUAGWU MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUMA
Authorized Official - Middle Name:CHIMEZIE
Authorized Official - Last Name:OSUAGWU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-766-1955
Mailing Address - Street 1:1302 KENT BROWN RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5218
Mailing Address - Country:US
Mailing Address - Phone:214-766-1955
Mailing Address - Fax:214-758-0636
Practice Address - Street 1:1015 W CENTERVILLE RD STE 118
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5929
Practice Address - Country:US
Practice Address - Phone:972-485-4440
Practice Address - Fax:972-807-6035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TXM4412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty