Provider Demographics
NPI:1205026333
Name:UBESIE, KANENECHUKWU VIRGINIA (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:KANENECHUKWU
Middle Name:VIRGINIA
Last Name:UBESIE
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:KANENE
Other - Middle Name:V
Other - Last Name:UBESIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:8700 STONEBROOK PKWY UNIT 958
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5804
Mailing Address - Country:US
Mailing Address - Phone:972-850-6122
Mailing Address - Fax:
Practice Address - Street 1:630 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2041
Practice Address - Country:US
Practice Address - Phone:903-606-5560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6716208600000X, 2086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery