Provider Demographics
NPI:1174967756
Name:EWELUKWA, MIRANDA ADANNA (MD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:ADANNA
Last Name:EWELUKWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIRANDA
Other - Middle Name:ADANNA
Other - Last Name:UZOMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5310 HARVEST HILL RD STE 290
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-5826
Mailing Address - Country:US
Mailing Address - Phone:214-420-0650
Mailing Address - Fax:
Practice Address - Street 1:1327 LAKE POINTE PKWY STE 416
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3499
Practice Address - Country:US
Practice Address - Phone:281-494-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7918207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology