Provider Demographics
NPI:1164579827
Name:ORIAKU, IHEONU USOUWA (MD)
Entity Type:Individual
Prefix:
First Name:IHEONU
Middle Name:USOUWA
Last Name:ORIAKU
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:P O BOX 2692
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32961-2692
Mailing Address - Country:US
Mailing Address - Phone:772-778-1603
Mailing Address - Fax:772-231-8470
Practice Address - Street 1:631 17TH STREET
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5518
Practice Address - Country:US
Practice Address - Phone:772-778-1603
Practice Address - Fax:772-231-8470
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79198208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259802700Medicaid
49280Medicare ID - Type UnspecifiedPROVIDER NUMBER
FL259802700Medicaid