Provider Demographics
NPI:1487616918
Name:AMADI, CHIKEZIE CHIDIEBERE (MD)
Entity type:Individual
Prefix:DR
First Name:CHIKEZIE
Middle Name:CHIDIEBERE
Last Name:AMADI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 N ZARAGOZA RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-8034
Mailing Address - Country:US
Mailing Address - Phone:915-373-9066
Mailing Address - Fax:915-298-5430
Practice Address - Street 1:1508 N ZARAGOZA RD STE ABCD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-8034
Practice Address - Country:US
Practice Address - Phone:915-373-9066
Practice Address - Fax:915-298-5430
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036173394207RI0011X
TXM9797207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204841501Medicaid
LA4J627Medicare ID - Type UnspecifiedMEDICARE#
LA1069400Medicaid