Provider Demographics
NPI:1487748661
Name:OSUAGWU, CHUKWUMA C
Entity type:Individual
Prefix:DR
First Name:CHUKWUMA
Middle Name:C
Last Name:OSUAGWU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 W CENTERVILLE RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-5914
Mailing Address - Country:US
Mailing Address - Phone:214-758-0332
Mailing Address - Fax:214-758-0636
Practice Address - Street 1:1015 W CENTERVILLE RD
Practice Address - Street 2:SUITE 118
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5914
Practice Address - Country:US
Practice Address - Phone:214-758-0332
Practice Address - Fax:214-758-0636
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM4412OtherMEDICAL LIS