Basic Information
| Provider Information | |||||||||
| NPI: | 1770786725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KALU-EGWIM | ||||||||
| FirstName: | STELLA | ||||||||
| MiddleName: | U | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.B.B.S | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KALU | ||||||||
| OtherFirstName: | STELLA | ||||||||
| OtherMiddleName: | U | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.B.B.S | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 BAYLOR PLZ | ||||||||
| Address2: | MS: BCM 320 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770303498 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328261385 | ||||||||
| FaxNumber: | 8328252799 | ||||||||
| Practice Location | |||||||||
| Address1: | 6621 FANNIN ST STE 6123 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328261365 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 48420-020 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | M8750 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | M8750 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 2080P0208X | M8750 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Infectious Diseases |
ID Information
| ID | Type | State | Issuer | Description | 189589803 | 05 | TX | MEDICAID |