Provider Demographics
NPI:1922449172
Name:ANAKO, CHINENYE CHIOMA (MD,)
Entity Type:Individual
Prefix:DR
First Name:CHINENYE
Middle Name:CHIOMA
Last Name:ANAKO
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 1:611 N. GLEN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614
Mailing Address - Country:US
Mailing Address - Phone:602-481-2040
Mailing Address - Fax:
Practice Address - Street 1:611 W GLEN AVE APT B
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4874
Practice Address - Country:US
Practice Address - Phone:602-481-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125064211208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice