Provider Demographics
NPI:1649569948
Name:MADUBUKO, ADAKU NGOZIKA (APN,NP)
Entity Type:Individual
Prefix:DR
First Name:ADAKU
Middle Name:NGOZIKA
Last Name:MADUBUKO
Suffix:
Gender:F
Credentials:APN,NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MD AT HOME
Mailing Address - Street 2:2003 W FULTON ST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-850-3437
Mailing Address - Fax:
Practice Address - Street 1:MD AT HOME
Practice Address - Street 2:2003 W FULTON
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-850-3437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.005994364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health