Provider Demographics
NPI:1194279539
Name:KEJO MEDICAL PLLC
Entity type:Organization
Organization Name:KEJO MEDICAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:NDUBISI
Authorized Official - Last Name:EZEUME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-321-7899
Mailing Address - Street 1:200 E MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-1811
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 E MILITARY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-1811
Practice Address - Country:US
Practice Address - Phone:248-747-1735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center