Provider Demographics
NPI:1790798015
Name:ONYEMERE, KINGSLEY U (MD)
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:U
Last Name:ONYEMERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1813 W. KIRBY AVENUE
Practice Address - Street 2:ENDOCRINOLOGY
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821
Practice Address - Country:US
Practice Address - Phone:217-383-3490
Practice Address - Fax:217-383-3439
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301083819207R00000X, 207RE0101X
IL036110498207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447860018Medicare NSC
I64870Medicare UPIN
ILIL3270127Medicare PIN