Individual
CHIDALU N. IBENEME
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ASSISTANT PHYSICIAN
Contact information
Practice address
13013 FULLER AVE STE A, GRANDVIEW, MO 64030-2687
(419) 204-9575
Mailing address
2900 OLD 63 S APT 102, COLUMBIA, MO 65201-5374
(419) 204-9575
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2024048683
MO
Other
Enumeration date
06/12/2025
Last updated
06/12/2025
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