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1629065131

NPI Code Detail

MEDICARE: DR. UYI-OGHOSA IDEMUDIA MD

MEDICARE: DR. UYI-OGHOSA IDEMUDIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	MD477800	PA
2	208M00000X	Hospitalist Physician	ME122009	FL
3	207R00000X	Internal Medicine Physician	41633	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	41633	OTHER	KY	KENTUCKY MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	ME122009	OTHER	FL	STATE MEDICAL LICENSE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629065131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. UYI-OGHOSA IDEMUDIA MD

Provider Business Mailing Address
First Line	:	222 MEDICAL CIR
Second Line	:
City	:	MOREHEAD
State	:	KY
Zip	:	40351-1179
Country	:	US
Telephone Number	:	606-783-6500
Fax Number	:	606-783-6878

Provider Business Practice Location Address
First Line	:	222 MEDICAL CIR
Second Line	:
City	:	MOREHEAD
State	:	KY
Zip	:	40351-1179
Country	:	US
Telephone Number	:	606-783-6500
Fax Number	:	606-783-6878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/07/2025

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Directions to “ DR. UYI-OGHOSA IDEMUDIA MD” Practice Location

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