Provider Demographics
NPI:1104490192
Name:KAMUCHEKA, TAWANDA STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:TAWANDA
Middle Name:STEPHEN
Last Name:KAMUCHEKA
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 1:16220 N US HWY 281 SUITE 300
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3585
Mailing Address - Country:US
Mailing Address - Phone:210-871-4701
Mailing Address - Fax:210-688-4596
Practice Address - Street 1:16620 N US HIGHWAY 281 STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2679
Practice Address - Country:US
Practice Address - Phone:210-871-4701
Practice Address - Fax:210-703-9155
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU3264207Q00000X, 208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist