| Bissonnet Internal Medicine PA | |
|
7737 Southwest Fwy Suite 620 Houston TX 77074-1807 | |
| (713) 484-9100 | |
| (713) 484-7558 |
| Full Name | Bissonnet Internal Medicine PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 7737 Southwest Fwy, Houston, Texas |
| Authorized Official Name and Position | Obiajulu Cletus Ezenwabachili (OWNER) |
| Authorized Official Contact | 7134849100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bissonnet Internal Medicine PA 7737 Southwest Fwy Suite 620 Houston TX 77074-1807 Ph: (713) 484-9100 | Bissonnet Internal Medicine PA 7737 Southwest Fwy Suite 620 Houston TX 77074-1807 Ph: (713) 484-9100 |
| NPI Number | 1902005473 |
|---|---|
| Provider Enumeration Date | 07/16/2007 |
| Last Update Date | 07/16/2007 |
| Medicare PECOS PAC ID | 3375523715 |
|---|---|
| Medicare Enrollment ID | O20040724000363 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902005473 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | L0158 (Texas) | Primary |
| Provider Name | Obiajulu C Ezenwabachili |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1518945674 PECOS PAC ID: 4082694427 Enrollment ID: I20040727001419 |
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