Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 22684 | SC |
Y | 207RP1001X | Pulmonary Disease | 22684 | SC |
NPI | 1043234834 |
---|---|
Provider Name | Dr. Ifeanyichukwu Madubobi Eruchalu |
First Address | Florence, SC 29502-3239 |
Second Address | Florence, SC 29506-2615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 14/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30791 | BCBS (01) | NC |
43275 | PARTNERS (01) | |
7007102 | AETNA (01) | |
8930791 | (05) | NC |
G11118 | (02) |