Provider Demographics
NPI:1689768525
Name:UDUMA, NDUKWE KALU (MD)
Entity Type:Individual
Prefix:
First Name:NDUKWE
Middle Name:KALU
Last Name:UDUMA
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 1:11937 US HIGHWAY 271
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75708-3154
Mailing Address - Country:US
Mailing Address - Phone:903-877-7168
Mailing Address - Fax:903-877-8355
Practice Address - Street 1:4101 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-6623
Practice Address - Country:US
Practice Address - Phone:903-594-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2381062084P0804X
TXM59552084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00692926OtherRAILROAD MEDICARE
TX8S5939OtherBCBS
TXP00692926Medicare PIN
TX8S5939OtherBCBS