Provider Demographics
NPI:1144724469
Name:IYAMU-OSAGIEDE, ESOHE (MD)
Entity type:Individual
Prefix:
First Name:ESOHE
Middle Name:
Last Name:IYAMU-OSAGIEDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8411 ADLER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5273
Mailing Address - Country:US
Mailing Address - Phone:832-573-3994
Mailing Address - Fax:832-626-2842
Practice Address - Street 1:5373 W ALABAMA ST STE 204
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5923
Practice Address - Country:US
Practice Address - Phone:888-803-3370
Practice Address - Fax:832-626-2842
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01086396A207Q00000X
390200000X
TXT8231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program