Provider Demographics
NPI:1952588055
Name:ODEZULU, ANGELA IFEOMA (DO)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:IFEOMA
Last Name:ODEZULU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:IFEOMA
Other - Last Name:NJOKU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8333 N DAVIS HWY FL 4
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-6050
Mailing Address - Country:US
Mailing Address - Phone:850-969-7979
Mailing Address - Fax:
Practice Address - Street 1:8333 N DAVIS HWY FL 4
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-969-7979
Practice Address - Fax:833-294-3763
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010005182207R00000X, 208M00000X
MELT17046207RC0000X
FLOS17328207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNA188OtherFL MEDICARE
IL1952588055Medicaid
MO1952588055Medicaid
FL108793400Medicaid