Provider Demographics
NPI:1396180154
Name:MADUIKE, KINGSLY I
Entity Type:Individual
Prefix:
First Name:KINGSLY
Middle Name:I
Last Name:MADUIKE
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 1:1575 DELUCCHI LN STE 207
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6563
Mailing Address - Country:US
Mailing Address - Phone:775-825-7500
Mailing Address - Fax:775-825-7550
Practice Address - Street 1:1575 DELUCCHI LN STE 207
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6563
Practice Address - Country:US
Practice Address - Phone:775-825-7500
Practice Address - Fax:775-825-7550
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst