Provider Demographics
NPI:1356191142
Name:UDOROH, IRIKEFE JUDE
Entity type:Individual
Prefix:
First Name:IRIKEFE
Middle Name:JUDE
Last Name:UDOROH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11615 FOREST CENTRAL DR STE 109
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3854
Mailing Address - Country:US
Mailing Address - Phone:469-768-2242
Mailing Address - Fax:
Practice Address - Street 1:11615 FOREST CENTRAL DR STE 109
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3854
Practice Address - Country:US
Practice Address - Phone:469-768-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide