MEDICARE: DR. THEOPHILUS IMBUFE DHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1083412613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THEOPHILUS IMBUFE DHA

Provider Business Mailing Address
First Line	:	4030 WAKE FOREST RD STE 349
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-0010
Country	:	US
Telephone Number	:	910-541-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1983 FAIRFOREST DR
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28304-2612
Country	:	US
Telephone Number	:	910-733-3737
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2025
Last Update Date	:	03/07/2025

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