Idemudia, Smart O

Idemudia, Smart O is an sole proprietor health care provider with primary practice located at 200 W. Southwest Pkwy , Lewisville TX 75067. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Idemudia, Smart O can be contacted via phone (972) 420-6777.

Contact Information

Primary practice address
200 W. Southwest Pkwy Lewisville TX 75067
Phone: (972) 420-6777
Fax: (972) 420-0656
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X J91000 Texas
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X J91000 Texas

Profile Details

NPI number 1154364974
LBN Legal business name Idemudia, Smart O
Credentials M.D., PHD
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 13th, 2006
Last updated Mar 5th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154364974 NPPES
Texas Other 0078DM BLUE CROSS / BLUE SHIELD
Texas Other F46614 BLUE CROSS / BLUE SHIELD

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