Provider Demographics
NPI:1255447421
Name:ANIEMEKA, NDUDI CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:NDUDI
Middle Name:CHRISTOPHER
Last Name:ANIEMEKA
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 1:5219 W MADISON ST
Mailing Address - Street 2:IST FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-4152
Mailing Address - Country:US
Mailing Address - Phone:773-378-4823
Mailing Address - Fax:773-378-9401
Practice Address - Street 1:5219 W MADISON ST
Practice Address - Street 2:IST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-4152
Practice Address - Country:US
Practice Address - Phone:773-378-4823
Practice Address - Fax:773-378-9401
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085291Medicaid
560320Medicare ID - Type Unspecified
IL036085291Medicaid
IL560320001Medicare PIN