Provider Demographics
NPI:1285523258
Name:MADU, EKENE OBINNA (BA)
Entity type:Individual
Prefix:
First Name:EKENE
Middle Name:OBINNA
Last Name:MADU
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 MOUNTAIN HAWK LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-7511
Mailing Address - Country:US
Mailing Address - Phone:505-416-1951
Mailing Address - Fax:
Practice Address - Street 1:6565 MOUNTAIN HAWK LOOP NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-7511
Practice Address - Country:US
Practice Address - Phone:505-416-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1618646749171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider