Provider Demographics
NPI:1417150509
Name:KALU, IFEOMA A (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEOMA
Middle Name:A
Last Name:KALU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2220
Mailing Address - Country:US
Mailing Address - Phone:972-579-8485
Mailing Address - Fax:
Practice Address - Street 1:1901 NORTH MAC ARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:972-579-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN6403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2172165-01Medicaid
TX217216502Medicaid
TX2172165-01Medicaid
TXTXB156010Medicare PIN
TXTXB112111Medicare PIN