Provider Demographics
NPI:1497524888
Name:KALU, CHIGOZIE EMMANUEL
Entity Type:Individual
Prefix:
First Name:CHIGOZIE
Middle Name:EMMANUEL
Last Name:KALU
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:TROY FAMILY PRACTICE
Mailing Address - Street 2:285 GUTHRIE DR.
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947
Mailing Address - Country:US
Mailing Address - Phone:570-297-4104
Mailing Address - Fax:
Practice Address - Street 1:TROY FAMILY PRACTICE
Practice Address - Street 2:285 GUTHRIE DR.
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947
Practice Address - Country:US
Practice Address - Phone:570-297-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily