Healthcare Provider Details

I. General information

NPI: 1245597178
Provider Name (Legal Business Name): IBUKUNOLUWA CHRISTINE KALU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ERWIN RD # DUMC3499
DURHAM NC
27705
US

IV. Provider business mailing address

2301 ERWIN RD # DUMC3499
DURHAM NC
27705-4699
US

V. Phone/Fax

Practice location:
  • Phone: 919-684-6335
  • Fax:
Mailing address:
  • Phone: 919-684-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number2018-00882
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018-00882
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: