Basic Information
| Provider Information | |||||||||
| NPI: | 1366056400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OMO-OGBOI | ||||||||
| FirstName: | ALLEN | ||||||||
| MiddleName: | CHUKWUEMEKENIM | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8181 FANNIN ST APT 1233 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770542920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327299103 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6431 FANNIN ST STE MSB 2136 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135004472 | ||||||||
| FaxNumber: | 7135000712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2020 | ||||||||
| LastUpdateDate: | 09/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | BP10070743 | TX | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.