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Organization
KUSI FORDJOUR M.D PA
Active
Organization
KUSI FORDJOUR M.D PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KUSI FORDJOUR MD (PRESIDENT AND CEO)
(214) 673-3934
Entity
Organization
Contact information
Practice address
2505 BOLTON BOONE DR, #101, DESOTO, TX 75115-2013
(972) 264-9100
(972) 283-9104
Mailing address
PO BOX 93597, SOUTHLAKE, TX 76092-0115
(972) 264-9100
(972) 283-9104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L0177
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0098MT
BCBS
TX
05
—
173380001
—
TX
01
—
L0177
LICENCE
TX
Enumeration date
05/10/2007
Last updated
05/25/2011
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