Individual
DR. KEVIN EMITSEILU IMMANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
6565 FANNIN ST, B452, HOUSTON, TX 77030-2703
(404) 723-8449
Mailing address
6565 FANNIN ST # B452, HOUSTON, TX 77030-2703
(404) 723-8449
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
003058
GA
2084N0400X
Neurology Physician
Primary
P6648
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340111901
—
TX
01
—
8FU287
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/25/2008
Last updated
05/24/2016
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