Provider Demographics
NPI:1306333901
Name:SCHULLE, ODINACHI IFEYINWA MOGHALU (DO)
Entity type:Individual
Prefix:
First Name:ODINACHI
Middle Name:IFEYINWA MOGHALU
Last Name:SCHULLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ODINACHI
Other - Middle Name:IFEYINWA
Other - Last Name:MOGHALU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:BAYLOR SCOTT & WHITE 2401 SOUTH 31ST STREET MS -A1-202,
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76508-0001
Mailing Address - Country:US
Mailing Address - Phone:214-771-1826
Mailing Address - Fax:
Practice Address - Street 1:BAYLOR SCOTT & WHITE MEDICAL CENTER-TEMPLE
Practice Address - Street 2:2401 SOUTH 31ST STREET, MS-A1-202,
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508
Practice Address - Country:US
Practice Address - Phone:254-724-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
DC390200000X
TX390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program