Provider Demographics
NPI:1063809531
Name:NGISHU, ROSE (MD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:NGISHU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N WALDROP DR STE 602
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4714
Mailing Address - Country:US
Mailing Address - Phone:817-277-4723
Mailing Address - Fax:817-274-5143
Practice Address - Street 1:1001 N WALDROP DR STE 602
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4714
Practice Address - Country:US
Practice Address - Phone:817-277-4723
Practice Address - Fax:817-274-5143
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6059207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200788280AMedicaid