Provider Demographics
NPI:1992764419
Name:EKONG, STELLA U (MD)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:U
Last Name:EKONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:E
Other - Last Name:ETUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:21922 BELLAIRE BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3919
Mailing Address - Country:US
Mailing Address - Phone:832-402-6326
Mailing Address - Fax:
Practice Address - Street 1:21922 BELLAIRE BLVD STE 600
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3919
Practice Address - Country:US
Practice Address - Phone:832-402-6326
Practice Address - Fax:713-424-2899
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN101774207Q00000X
MN47645207Q00000X
TXR7720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35488Medicare UPIN
080014297Medicare ID - Type Unspecified