Basic Information
| Provider Information | |||||||||
| NPI: | 1871857276 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMADI | ||||||||
| FirstName: | KEMBUKEM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2147 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339022147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394241449 | ||||||||
| FaxNumber: | 2394241421 | ||||||||
| Practice Location | |||||||||
| Address1: | 9981 S HEALTHPARK DR # 2-WEST | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339083618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2343432052 | ||||||||
| FaxNumber: | 2393435348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2012 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.134448 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 51687 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 081653 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 57992 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C10012939 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME125082 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.