MEDICARE: EMMANUEL ILOH 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	207P00000X	Emergency Medicine Physician	38934	TN
2	207R00000X	Internal Medicine Physician	038934	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	4114553	OTHER	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4114557	OTHER	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801826961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMANUEL ILOH MD

Provider Business Mailing Address
First Line	:	3950 NEW COVINGTON PIKE STE 130
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2595
Country	:	US
Telephone Number	:	901-388-0404
Fax Number	:	901-388-0484

Provider Business Practice Location Address
First Line	:	3950 NEW COVINGTON PIKE STE 130
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38128-2595
Country	:	US
Telephone Number	:	901-388-0404
Fax Number	:	901-388-0484

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	01/17/2011

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Directions to “ EMMANUEL ILOH MD” Practice Location

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