Healthcare Provider Details

I. General information

NPI: 1013963750
Provider Name (Legal Business Name): MALACHY IKECHUKWU IJEMERE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S 3RD ST
GADSDEN AL
35901-5304
US

IV. Provider business mailing address

PO BOX 863535
ORLANDO FL
32886-3535
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-1300
  • Fax: 904-805-1302
Mailing address:
  • Phone: 904-805-1300
  • Fax: 904-805-1302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19349
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: