Provider Demographics
NPI:1437491123
Name:MADU, GABRIEL IKEMBA (MD, DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:IKEMBA
Last Name:MADU
Suffix:
Gender:M
Credentials:MD, DO, MPH
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2514 67TH AVENUE LOOP STE 112
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-7260
Mailing Address - Country:US
Mailing Address - Phone:601-482-4955
Mailing Address - Fax:
Practice Address - Street 1:2363 HIGHWAY 1 S
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-8337
Practice Address - Country:US
Practice Address - Phone:662-334-1253
Practice Address - Fax:662-741-2700
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-3270207Q00000X, 390200000X
MS25560207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program