Provider Demographics
NPI:1982319778
Name:E-Z MED URGENT CARE AND WEIGHT LOSS INC
Entity type:Organization
Organization Name:E-Z MED URGENT CARE AND WEIGHT LOSS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IBIDUNNI
Authorized Official - Middle Name:
Authorized Official - Last Name:UKEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-366-4604
Mailing Address - Street 1:2727 BOLTON BOONE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2019
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1004 S CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1527
Practice Address - Country:US
Practice Address - Phone:817-366-4604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care