Individual
IBANGA MICHAEL EKANEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 PADUCAH DR, NEW MARTINSVILLE, WV 26155
(304) 455-3611
(304) 455-1778
Mailing address
100 PADUCAH DR, NEW MARTINSVILLE, WV 26155
(304) 455-3611
(304) 455-1778
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
19922
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801553000
—
WV
Enumeration date
09/20/2006
Last updated
04/18/2022
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