Provider Demographics
NPI:1750422143
Name:IFEDIBA, UCHENNA GRACE (MD)
Entity type:Individual
Prefix:DR
First Name:UCHENNA
Middle Name:GRACE
Last Name:IFEDIBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5037 CASTLE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:SHOAL CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6438
Mailing Address - Country:US
Mailing Address - Phone:205-929-0565
Mailing Address - Fax:205-929-0564
Practice Address - Street 1:1300 BESSEMER RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35208-4326
Practice Address - Country:US
Practice Address - Phone:205-929-0565
Practice Address - Fax:205-929-0564
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554813Medicaid
AL051554813IFEMedicare ID - Type Unspecified
AL051554813Medicaid