Provider Demographics
NPI:1831765502
Name:ODUBA, KIKELOMO (MD, MPH, CIC)
Entity type:Individual
Prefix:
First Name:KIKELOMO
Middle Name:
Last Name:ODUBA
Suffix:
Gender:F
Credentials:MD, MPH, CIC
Other - Prefix:DR
Other - First Name:KIKE
Other - Middle Name:
Other - Last Name:ODUBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8118 FRY RD STE 1303
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7852
Mailing Address - Country:US
Mailing Address - Phone:832-779-2347
Mailing Address - Fax:
Practice Address - Street 1:8118 FRY RD STE 1303
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7852
Practice Address - Country:US
Practice Address - Phone:832-779-2347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare