Provider Demographics
NPI:1437270279
Name:NYALUGWE, MABALA G (MD)
Entity Type:Individual
Prefix:DR
First Name:MABALA
Middle Name:G
Last Name:NYALUGWE
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:PO BOX 118
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-0118
Mailing Address - Country:US
Mailing Address - Phone:765-765-8055
Mailing Address - Fax:
Practice Address - Street 1:417 N RESERVE ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3856
Practice Address - Country:US
Practice Address - Phone:765-876-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043016A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine