Provider Demographics
NPI:1629482203
Name:HYDUKE, ODERA UMEANO (MD)
Entity Type:Individual
Prefix:DR
First Name:ODERA
Middle Name:UMEANO
Last Name:HYDUKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ODERA
Other - Middle Name:ADAMMA
Other - Last Name:UMEANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-765-4050
Practice Address - Fax:225-765-4046
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201800818207R00000X
LA324198208M00000X, 207R00000X
390200000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program