Provider Demographics
NPI:1851459697
Name:TSHIBAKA, CIMENGA M (MD)
Entity Type:Individual
Prefix:DR
First Name:CIMENGA
Middle Name:M
Last Name:TSHIBAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9178
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811-9178
Mailing Address - Country:US
Mailing Address - Phone:855-498-6768
Mailing Address - Fax:479-968-1673
Practice Address - Street 1:415 HOSPITAL DR STE 3
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-4651
Practice Address - Country:US
Practice Address - Phone:870-837-2888
Practice Address - Fax:870-837-2892
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-16004208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007876000Medicaid
H458N759Medicare ID - Type Unspecified
I51596Medicare UPIN