Provider Demographics
NPI:1417988445
Name:AJAELO, IKEMEFUNA CHUKWUEMEKA
Entity Type:Individual
Prefix:
First Name:IKEMEFUNA
Middle Name:CHUKWUEMEKA
Last Name:AJAELO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:IKEM
Other - Middle Name:CHUKWUEMEKA
Other - Last Name:AJAELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1450 TREAT BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-296-9000
Mailing Address - Fax:
Practice Address - Street 1:750 E 34TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-2341
Practice Address - Country:US
Practice Address - Phone:218-262-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47833207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN851458500Medicaid
MN851458500Medicaid
MN930002393Medicare PIN