Provider Demographics
NPI:1861685372
Name:ODOGWU, MADUKA HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:MADUKA
Middle Name:HAROLD
Last Name:ODOGWU
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 1:1010 N BELT LINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1770
Mailing Address - Country:US
Mailing Address - Phone:469-862-3756
Mailing Address - Fax:469-862-3766
Practice Address - Street 1:1010 N BELT LINE RD STE 101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1770
Practice Address - Country:US
Practice Address - Phone:469-862-3756
Practice Address - Fax:469-862-3766
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2022-09-26
Deactivation Date:2022-08-30
Deactivation Code:
Reactivation Date:2022-09-21
Provider Licenses
StateLicense IDTaxonomies
SC33863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37996702Medicaid
TX652387OtherMEDICARE
SC33863OtherSTATE LICENSE
SC338637Medicaid
TXQ8981OtherSTATE LICENSE