Individual
DR. CEISHA UKATU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12001 SOUTH FWY STE 209, BURLESON, TX 76028-7214
(682) 385-7010
(682) 385-7011
Mailing address
PO BOX 6278, FORT WORTH, TX 76115-0278
(682) 385-7010
(682) 385-7011
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
036.166777
IL
207Y00000X
Otolaryngology Physician
2014021212
MO
207Y00000X
Otolaryngology Physician
Primary
R9879
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
399828801
—
TX
01
—
813017
MEDICARE
TX
Enumeration date
06/27/2014
Last updated
08/29/2023
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