Provider Demographics
NPI:1043234834
Name:ERUCHALU, IFEANYICHUKWU MADUBOBI (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEANYICHUKWU
Middle Name:MADUBOBI
Last Name:ERUCHALU
Suffix:
Gender:M
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:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7863
Mailing Address - Fax:843-777-7873
Practice Address - Street 1:401 E CHEVES ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2615
Practice Address - Country:US
Practice Address - Phone:843-777-7863
Practice Address - Fax:843-777-7873
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22684207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
43275OtherPARTNERS
NC8930791Medicaid
7007102OtherAETNA
NC30791OtherBCBS
7007102OtherAETNA
NC8930791Medicaid