Healthcare Provider Details

I. General information

NPI: 1285373548
Provider Name (Legal Business Name): FAITH MADUKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 TROY RD
EDWARDSVILLE IL
62025-2540
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-2540
US

V. Phone/Fax

Practice location:
  • Phone: 618-800-4500
  • Fax:
Mailing address:
  • Phone: 618-800-4500
  • Fax: 618-800-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036174838
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: