Provider Demographics
NPI:1417912932
Name:AFULUKWE, IFEDIORA FOSTER (MD)
Entity Type:Individual
Prefix:
First Name:IFEDIORA
Middle Name:FOSTER
Last Name:AFULUKWE
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:PO BOX 49089
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0073
Mailing Address - Country:US
Mailing Address - Phone:803-273-4018
Mailing Address - Fax:803-273-4023
Practice Address - Street 1:209 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HEATH SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29058-9710
Practice Address - Country:US
Practice Address - Phone:803-273-4018
Practice Address - Fax:803-273-4023
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD20627207RP1001X, 207R00000X
SC20627207RS0012X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2762Medicaid
SCGP2762Medicaid
SCG82598Medicare UPIN