Provider Demographics
NPI:1043742752
Name:MADUKA, SOBIE
Entity Type:Individual
Prefix:
First Name:SOBIE
Middle Name:
Last Name:MADUKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2933
Mailing Address - Country:US
Mailing Address - Phone:325-670-5530
Mailing Address - Fax:833-247-3176
Practice Address - Street 1:1210 N 18TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2933
Practice Address - Country:US
Practice Address - Phone:325-670-5530
Practice Address - Fax:833-247-3176
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS4809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty