Provider Demographics
NPI:1275111981
Name:ODIMEGWU, AMAKA YVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAKA
Middle Name:YVONNE
Last Name:ODIMEGWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMAKA
Other - Middle Name:YVONNE
Other - Last Name:EZISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1400 S COULTER ST STE 2500
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1786
Mailing Address - Country:US
Mailing Address - Phone:806-414-9100
Mailing Address - Fax:806-354-5717
Practice Address - Street 1:1400 S COULTER ST STE 2500
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1786
Practice Address - Country:US
Practice Address - Phone:806-414-9100
Practice Address - Fax:806-354-5717
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program