Provider Demographics
NPI:1114912557
Name:MADUAKOLAM, CHINEDU UZOMA (MD)
Entity Type:Individual
Prefix:
First Name:CHINEDU
Middle Name:UZOMA
Last Name:MADUAKOLAM
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 1:6865 PARKDALE PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5654
Mailing Address - Country:US
Mailing Address - Phone:317-291-1211
Mailing Address - Fax:317-291-1194
Practice Address - Street 1:6865 PARKDALE PL
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5654
Practice Address - Country:US
Practice Address - Phone:317-291-1211
Practice Address - Fax:317-291-1194
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060259A174400000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200811710Medicaid
IN20811710Medicaid
KY7100130540Medicaid
KY7100130540Medicaid
IN200811710Medicaid
IN131180XXMedicare PIN