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833 E Northwest Hwy Ste 400 Grapevine TX 76051-3302 | |
| (817) 778-0191 | |
| (817) 421-2940 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 833 E Northwest Hwy Ste 400, Grapevine, Texas |
| Authorized Official Name and Position | Omotayo Onanuga (MD) |
| Authorized Official Contact | 8177710191 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 2043 Grapevine TX 76099-2043 Ph: (817) 778-0191 | 833 E Northwest Hwy Ste 400 Grapevine TX 76051-3302 Ph: (817) 778-0191 |
| NPI Number | 1295152148 |
|---|---|
| Provider Enumeration Date | 03/27/2014 |
| Last Update Date | 12/03/2024 |
| Certification Date | 12/03/2024 |
| Medicare PECOS PAC ID | 9032334040 |
|---|---|
| Medicare Enrollment ID | O20140708000942 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295152148 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Omotayo Onanuga |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518989474 PECOS PAC ID: 9638118144 Enrollment ID: I20140708001132 |
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