Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | MD24195 | ME |
NPI | 1154706588 |
---|---|
Provider Name | Sandra Ilaka-Chibuluzo |
First Address | Bangor, ME 04401-4312 |
Second Address | Bangor, ME 04401-4312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2015 |
Last Update Date | 03/02/2022 |