Provider Demographics
NPI:1801826961
Name:ILOH, EMMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:
Last Name:ILOH
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 1:3950 NEW COVINGTON PIKE STE 130
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38128-2595
Mailing Address - Country:US
Mailing Address - Phone:901-388-0404
Mailing Address - Fax:901-388-0484
Practice Address - Street 1:3950 NEW COVINGTON PIKE STE 130
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38128-2595
Practice Address - Country:US
Practice Address - Phone:901-388-0404
Practice Address - Fax:901-388-0484
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38934207P00000X
TN038934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4114553OtherBCBS
TN3898246Medicaid
TN3898249Medicaid
4114557OtherBCBS
TN3898249Medicare PIN
4114557OtherBCBS
TNI16456Medicare UPIN