Provider Demographics
NPI:1043443401
Name:IZEDIUNO, IFEANYI (MD)
Entity Type:Individual
Prefix:DR
First Name:IFEANYI
Middle Name:
Last Name:IZEDIUNO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 MAIN ST STE 284
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-4527
Mailing Address - Country:US
Mailing Address - Phone:469-929-1199
Mailing Address - Fax:469-582-0094
Practice Address - Street 1:2770 MAIN ST STE 284
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-4527
Practice Address - Country:US
Practice Address - Phone:469-929-1199
Practice Address - Fax:469-582-0094
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20130028002084P0800X
390200000X
TXQ30172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program