Organization
NORTHSIDE PEDIATRICS ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL E OKOGBO M.D. (OWNER)
(806) 626-3808
Entity
Organization
Contact information
Practice address
15210 I-45 SOUTH, SUITE 110, CONROE, TX 77384-4105
(936) 270-8655
Mailing address
15210 I-45 S, SUITE 110, CONROE, TX 77384-4105
(936) 270-8655
(936) 270-8739
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K4516
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043224132
NPI
TX
01
—
1609104785
NPI
TX
Enumeration date
08/28/2016
Last updated
04/19/2017
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