Provider Demographics
NPI:1306008180
Name:ONYEDIKA, IKECHUKWU IFEANYI (MD)
Entity Type:Individual
Prefix:
First Name:IKECHUKWU
Middle Name:IFEANYI
Last Name:ONYEDIKA
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 1:4646 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6104
Mailing Address - Country:US
Mailing Address - Phone:915-313-6300
Mailing Address - Fax:915-521-2028
Practice Address - Street 1:4646 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6104
Practice Address - Country:US
Practice Address - Phone:915-313-6300
Practice Address - Fax:915-521-2028
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1096207XP3100X
WA60554349207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR1096OtherTEXAS MEDICAL LICENSE