Provider Demographics
NPI:1316250483
Name:ANITUBE, MAXIMUS NWAKALUNNA (MD)
Entity type:Individual
Prefix:
First Name:MAXIMUS
Middle Name:NWAKALUNNA
Last Name:ANITUBE
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 1:1704 LISBURN DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3348
Mailing Address - Country:US
Mailing Address - Phone:617-838-5373
Mailing Address - Fax:
Practice Address - Street 1:4817 MEDICAL CENTER DR STE 3A
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1886
Practice Address - Country:US
Practice Address - Phone:972-607-9650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1984082084P0800X
TXP50242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry