Provider Demographics
NPI:1164664066
Name:EMEREUWAONU, IKECHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:IKECHUKWU
Middle Name:
Last Name:EMEREUWAONU
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 1:8045 CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5977
Mailing Address - Country:US
Mailing Address - Phone:901-249-0847
Mailing Address - Fax:833-673-0465
Practice Address - Street 1:8045 CLUB PKWY
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5977
Practice Address - Country:US
Practice Address - Phone:901-249-0847
Practice Address - Fax:833-673-0465
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45984207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ656470Medicaid
AZZ149184Medicare PIN