Provider Demographics
NPI:1720252570
Name:ANUSIONWU, IFEANYICHUKWU (MD)
Entity Type:Individual
Prefix:MS
First Name:IFEANYICHUKWU
Middle Name:
Last Name:ANUSIONWU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IFEANYICHUKWU
Other - Middle Name:
Other - Last Name:MEGWALU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6138 PRECINCT LINE RD UNIT 100
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-2617
Mailing Address - Country:US
Mailing Address - Phone:817-849-2410
Mailing Address - Fax:817-849-2202
Practice Address - Street 1:6138 PRECINCT LINE RD UNIT 100
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2617
Practice Address - Country:US
Practice Address - Phone:817-849-2410
Practice Address - Fax:817-849-2202
Is Sole Proprietor?:No
Enumeration Date:2008-04-14
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450393208800000X
TXR9913208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology