Provider Demographics
NPI:1841964939
Name:IDEMUDIA, NOSAKHARE (MD)
Entity type:Individual
Prefix:DR
First Name:NOSAKHARE
Middle Name:
Last Name:IDEMUDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:NOSA
Other - Middle Name:
Other - Last Name:IDEMUDIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3700 KENTMERE CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-8464
Mailing Address - Country:US
Mailing Address - Phone:214-695-4212
Mailing Address - Fax:
Practice Address - Street 1:14000 FIVAY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7103
Practice Address - Country:US
Practice Address - Phone:727-819-2966
Practice Address - Fax:727-819-2928
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program