DR. IMA MBODIE EBONG (NPI# 1891037230) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891037230 |
| Entity Type | Individual |
| Full Name | DR. IMA MBODIE EBONG |
| Credential | MD |
| Practice Address |
740 S Limestone Ky Clinic J401 Lexington KY 40536 |
| Mailing Address |
740 S Limestone Ky Clinic J401 Lexington KY 40536-0284 |
| Practice Telephone | 8593235661 |
| Mailing Telephone | 8593235661 |
| Enumeration Date | 2013-03-24 |
| Last Update Date | 2018-06-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0600X |
Psychiatry & Neurology Specialization: Clinical Neurophysiology |
51368 | KY | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | FL | Student, Health Care |
| Street Address |
740 S LIMESTONE KY CLINIC J401 |
| City | LEXINGTON |
| State | KY |
| Zip Code | 40536 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972576940 | Jagannadha Rao Avasarala | Psychiatry & Neurology | 740 S Limestone Ky Clinic J401, Lexington, KY 40536-0001 | 2006-02-09 |
| 1295149185 | Mam Ismaail Ibraheem | Psychiatry & Neurology | 740 S Limestone Ky Clinic J401, Lexington, KY 40536 | 2014-06-18 |
| 1093830572 | Richard Daniel King | Psychiatry & Neurology | 740 S Limestone Ky Clinic J401, Lexington, KY 40536-0284 | 2007-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790394583 | Mary Luz Calderon | Physician Assistant | Uk Pediatric Neonatology, 800 Rose St 4th Fl, Lexington, KY 40536 | 2020-07-28 |
| 1598389421 | Storm Bryant Dutton | Physician Assistant | Uk Emergency Department - Chandler, 1000 S Limestone, Lexington, KY 40536 | 2020-06-06 |
| 1720601545 | Tyler Allen Pape | Physician Assistant | Uk Surgery Clinic - General, 740 S Limestone Ste L104, Lexington, KY 40536 | 2020-05-27 |
| 1417579269 | Kacy Clinkenbeard | Physician Assistant | Uk Healthcare-icu, 800 Rose St, Lexington, KY 40536 | 2020-05-15 |
| 1023578804 | William Chalmers Ruffin | Student in an Organized Health Care Education/Training Program | 740 South Limestone St. E300e, Lexington, KY 40536 | 2019-03-20 |
| 1942705728 | Karah Lee Ellen Brown | Dentist | 800 Rose Street, Room D-508, Lexington, KY 40536 | 2018-03-26 |
| 1982109708 | Khader Samir Habash | Dentist | 740 S Limestone Room A262, Lexington, KY 40536 | 2018-03-25 |
| 1609370683 | Casey Michael Fitzgerald | Otolaryngology | 740 South Limestone Ears Nose and Throat Clinic, Lexington, KY 40536 | 2018-03-22 |
| 1538663992 | Heather Oaks | Nurse Practitioner | Uk Gill Heart Institute 800 Rose St, Lexington, KY 40536 | 2018-03-21 |
| 1396268223 | Prasanna Kumar Gangishetti | Pediatrics | 800 Rose St Rm No Mn-118, Lexington, KY 40536 | 2017-07-23 |
| Find all providers in zip 40536 | ||||
| Taxonomy Code | 2084N0600X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Clinical Neurophysiology |
| Clinical Neurophysiology is a subspecialty with psychiatric or neurologic expertise in the diagnosis and management of central, peripheral, and autonomic nervous system disorders using combined clinical evaluation and electrophysiologic testing such as electroencephalography (EEG), electromyography (EMG), and nerve conduction studies (NCS). |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902853617 | Warren F. Chumley | Psychiatry & Neurology | 1021 Majestic Drive, Suite 200, Lexington, KY 40513 | 2006-05-28 |
| 1154368801 | Greg L. Anderson | Psychiatry & Neurology | 1021 Majestic Drive, Suite 200, Lexington, KY 40513 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205037470 | Ty Brown | Psychiatry & Neurology | 2670 Chancellor Drive, Crestview Hills, KY 41017-5466 | 2007-05-29 |
| 1467450601 | Vasudeva G. Iyer | Psychiatry & Neurology | 2505 Bush Ridge Dr, Suite A, Louisville, KY 40245-5885 | 2005-07-12 |
| 1366671265 | Disha Shah | Psychiatry & Neurology | 6400 Dutchmans Pkwy, Suite 175, Louisville, KY 40205-3340 | 2009-07-13 |
| 1144456757 | Iyer Neurology Pllc | Psychiatry & Neurology | 2505 Bush Ridge Dr, Suite A, Louisville, KY 40245-5885 | 2009-06-09 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.