Provider Demographics
NPI:1295761799
Name:ADUGBA, IKENNA (MD)
Entity type:Individual
Prefix:DR
First Name:IKENNA
Middle Name:
Last Name:ADUGBA
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 1:2185 BRINKER RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6986
Mailing Address - Country:US
Mailing Address - Phone:940-384-1809
Mailing Address - Fax:940-384-7744
Practice Address - Street 1:2185 BRINKER RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6986
Practice Address - Country:US
Practice Address - Phone:940-384-1809
Practice Address - Fax:940-384-7744
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161797901Medicaid
TX131165611Medicaid
TX131165611Medicaid
TXG95659Medicare UPIN