Provider Demographics
NPI:1043044183
Name:MICHEAL, CHIBUZO IKECHUKWU (CEO)
Entity type:Individual
Prefix:
First Name:CHIBUZO
Middle Name:IKECHUKWU
Last Name:MICHEAL
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7713 BELMAC LN
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8758
Mailing Address - Country:US
Mailing Address - Phone:317-515-2011
Mailing Address - Fax:
Practice Address - Street 1:7713 BELMAC LN
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8758
Practice Address - Country:US
Practice Address - Phone:317-515-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-016599-1374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide