=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043742752
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SOBIE MADUKA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2017
-----------------------------------------------------
Last Update Date | 05/06/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1150 N 18TH ST STE 200
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79601-2931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-670-5530
-----------------------------------------------------
Fax | 833-437-1259
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1150 N 18TH ST STE 200
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79601-2931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-670-5530
-----------------------------------------------------
Fax | 833-437-1259
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | S4809
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------