Provider Demographics
NPI:1356518856
Name:ONWUMERE, IKENNA UGOCHUKWU (MD)
Entity type:Individual
Prefix:DR
First Name:IKENNA
Middle Name:UGOCHUKWU
Last Name:ONWUMERE
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:PO BOX 741221
Mailing Address - Street 2:IPM CREDENTIALING
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1221
Mailing Address - Country:US
Mailing Address - Phone:903-416-1710
Mailing Address - Fax:903-416-4137
Practice Address - Street 1:302 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6302
Practice Address - Country:US
Practice Address - Phone:270-473-0819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278595207R00000X
KY43138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC351327Medicaid
KY7100103060Medicaid
KYK044830Medicare PIN