Individual
DR. IMAM EKO TJAHJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12340 BANDERA RD STE 104, HELOTES, TX 78023
(210) 920-8000
(210) 920-6000
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 606-6400
(903) 606-1522
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
J9393
TX
207RC0000X
Cardiovascular Disease Physician
Primary
J9393
TX
207RI0011X
Interventional Cardiology Physician
J9393
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104420801
—
TX
01
—
629794AS1D
MEDICARE ID
TX
Enumeration date
10/27/2005
Last updated
09/09/2025
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