Provider Demographics
NPI:1043852346
Name:MBANU, CHIJIOKE ANAELE (PHD)
Entity Type:Individual
Prefix:
First Name:CHIJIOKE
Middle Name:ANAELE
Last Name:MBANU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11133 GLEN AVON WAY
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1287
Mailing Address - Country:US
Mailing Address - Phone:773-706-5130
Mailing Address - Fax:
Practice Address - Street 1:11133 GLEN AVON WAY
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1287
Practice Address - Country:US
Practice Address - Phone:773-706-5130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care