Provider Demographics
NPI:1245530146
Name:MADUKA, IHEANYI CHUCK (PA-C)
Entity type:Individual
Prefix:MR
First Name:IHEANYI
Middle Name:CHUCK
Last Name:MADUKA
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:250 BLOSSOM ST STE 120
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4243
Mailing Address - Country:US
Mailing Address - Phone:713-973-7246
Mailing Address - Fax:832-553-1337
Practice Address - Street 1:250 BLOSSOM ST STE 120
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4243
Practice Address - Country:US
Practice Address - Phone:713-973-7246
Practice Address - Fax:832-553-1337
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06602363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical