Provider Demographics
NPI:1265673529
Name:CHIEMELU, KANAYO
Entity Type:Individual
Prefix:MR
First Name:KANAYO
Middle Name:
Last Name:CHIEMELU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 COORS BLVD NW
Mailing Address - Street 2:STE J
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1269
Mailing Address - Country:US
Mailing Address - Phone:505-459-5757
Mailing Address - Fax:505-884-4449
Practice Address - Street 1:3200 COORS BLVD NW
Practice Address - Street 2:STE J
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1269
Practice Address - Country:US
Practice Address - Phone:505-459-5757
Practice Address - Fax:505-884-4449
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
No172A00000XOther Service ProvidersDriver