Provider Demographics
NPI:1396737730
Name:OGBONNAYA, KALU IREM (MD, PA)
Entity type:Individual
Prefix:DR
First Name:KALU
Middle Name:IREM
Last Name:OGBONNAYA
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9888 BISSONNET ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8247
Mailing Address - Country:US
Mailing Address - Phone:713-272-3780
Mailing Address - Fax:713-272-3748
Practice Address - Street 1:9888 BISSONNET ST
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8247
Practice Address - Country:US
Practice Address - Phone:713-272-3780
Practice Address - Fax:713-272-3748
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG7415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157872602Medicaid
TX129052006Medicaid
TX8996B9Medicare ID - Type Unspecified
TXB25238Medicare UPIN
TX157872602Medicaid