Provider Demographics
NPI:1477693554
Name:OSUORJI, IKENNA C (MD)
Entity Type:Individual
Prefix:
First Name:IKENNA
Middle Name:C
Last Name:OSUORJI
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 1:4050 NORTHRISE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7327
Mailing Address - Country:US
Mailing Address - Phone:575-650-3335
Mailing Address - Fax:575-652-3093
Practice Address - Street 1:4050 NORTHRISE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7327
Practice Address - Country:US
Practice Address - Phone:575-652-3040
Practice Address - Fax:575-652-3093
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS5241207RH0003X
390200000X
NMMD2014-0490207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program