Basic Information
Provider Information | |||||||||
NPI: | 1669712980 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANEMELU | ||||||||
FirstName: | MIRIAM | ||||||||
MiddleName: | UCHENNA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MADUAGWU | ||||||||
OtherFirstName: | MIRIAM | ||||||||
OtherMiddleName: | UCHENNA | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 909 FROSTWOOD DR STE 1.100 | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770242301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7133386353 | ||||||||
FaxNumber: | 7137043086 | ||||||||
Practice Location | |||||||||
Address1: | 1635 NORTH LOOP W | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770081532 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7138672066 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/22/2013 | ||||||||
LastUpdateDate: | 03/10/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/10/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A122165 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | R3135 | TX | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | A122165 | CA | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 208M00000X | R3135 | TX | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
No ID Information.