Provider Demographics
NPI:1083412613
Name:IMBUFE, THEOPHILUS (DHA)
Entity type:Individual
Prefix:DR
First Name:THEOPHILUS
Middle Name:
Last Name:IMBUFE
Suffix:
Gender:
Credentials:DHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 WAKE FOREST RD STE 349
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-0010
Mailing Address - Country:US
Mailing Address - Phone:910-541-5188
Mailing Address - Fax:
Practice Address - Street 1:1983 FAIRFOREST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2612
Practice Address - Country:US
Practice Address - Phone:910-733-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health