Provider Demographics
NPI:1649267006
Name:UMANA, UKEME (MD)
Entity type:Individual
Prefix:DR
First Name:UKEME
Middle Name:
Last Name:UMANA
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 1:1200 W DEYOUNG ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4437
Mailing Address - Country:US
Mailing Address - Phone:618-993-5686
Mailing Address - Fax:618-997-6250
Practice Address - Street 1:1200 W DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4437
Practice Address - Country:US
Practice Address - Phone:618-993-5686
Practice Address - Fax:618-997-6250
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078492207W00000X
MOMD102163207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0814870027OtherMEDICARE NSC NUMBER
IL0814870022OtherMEDICARE NSC NUMBER
MO133944OtherANTHEM BLUE CROSS BLUE SHIELD OF MO
IL036078492Medicaid
IL0814870010OtherMEDICARE NSC NUMBER
MO203419809Medicaid
238797OtherHARMONY HEALTH PLAN
MO0814870013OtherMEDICARE NSC NUMBER
IL0814870003OtherMEDICARE NSC NUMBER
IL0814870012OtherMEDICARE NSC NUMBER
101234OtherHEALTHLINK
IL180018475OtherMEDICARE RAILROAD
034234OtherHEALTH ALLIANCE
IL0814870001OtherMEDICARE NSC NUMBER
IL0814870007OtherMEDICARE NSC NUMBER
IL0814870011OtherMEDICARE NSC NUMBER
238797OtherHARMONY HEALTH PLAN
IL0814870022OtherMEDICARE NSC NUMBER
IL0814870027OtherMEDICARE NSC NUMBER