Provider Demographics
NPI:1881858165
Name:ANIMALU, CHINELO NGOZI (MD)
Entity Type:Individual
Prefix:
First Name:CHINELO
Middle Name:NGOZI
Last Name:ANIMALU
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 1000
Mailing Address - Street 2:DEPT # 457
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-758-7888
Mailing Address - Fax:901-387-5157
Practice Address - Street 1:1325 EASTMORELAND AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3519
Practice Address - Country:US
Practice Address - Phone:901-758-7888
Practice Address - Fax:901-387-5157
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50126207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR210841001Medicaid
TN5448780OtherBCBS
TNQ014407Medicaid
MS05087052Medicaid
AR210841001Medicaid