Provider Demographics
NPI:1568844322
Name:MADUBOM, CHINELO (MD)
Entity type:Individual
Prefix:
First Name:CHINELO
Middle Name:
Last Name:MADUBOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHINELO
Other - Middle Name:
Other - Last Name:MADUBOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:18400 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1286
Practice Address - Country:US
Practice Address - Phone:281-492-1900
Practice Address - Fax:281-492-1060
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR9249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine