Provider Demographics
NPI:1598085771
Name:IKEDIOBI, UCHENNA THERESE (MD)
Entity Type:Individual
Prefix:
First Name:UCHENNA
Middle Name:THERESE
Last Name:IKEDIOBI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10004 KENNERLY RD STE 171B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2176
Mailing Address - Country:US
Mailing Address - Phone:314-821-0900
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD STE 171B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2176
Practice Address - Country:US
Practice Address - Phone:314-821-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8949207R00000X
CT54566207RI0200X
CT390200000X
MO2022027324207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program