Provider Demographics
NPI:1952352510
Name:NTENDE, HENRY WAKIKU (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WAKIKU
Last Name:NTENDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 SUNBURST DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5116
Mailing Address - Country:US
Mailing Address - Phone:432-247-1760
Mailing Address - Fax:
Practice Address - Street 1:8050 HIGHWAY 191
Practice Address - Street 2:SUITE 202
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8613
Practice Address - Country:US
Practice Address - Phone:432-312-6065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3610207P00000X
VA0101245604207R00000X
OH35.070698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149496001Medicaid
ARG58730Medicare UPIN
AR5L668C937Medicare ID - Type Unspecified
AR149496001Medicaid