Provider Demographics
NPI:1710988662
Name:MADU, IVY-JOAN ERINMA (MD)
Entity Type:Individual
Prefix:DR
First Name:IVY-JOAN
Middle Name:ERINMA
Last Name:MADU
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 1693
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92856-0693
Mailing Address - Country:US
Mailing Address - Phone:714-639-1815
Mailing Address - Fax:
Practice Address - Street 1:1310 W STEWART DR STE 610
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3857
Practice Address - Country:US
Practice Address - Phone:714-639-1815
Practice Address - Fax:714-639-2374
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50150207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A501500Medicaid
CA00A501500OtherCALOPTIMA
CAG25782Medicare UPIN