Healthcare Provider Details

I. General information

NPI: 1497729610
Provider Name (Legal Business Name): WILFRED IKEMEFUNA ONYIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 GROVELAND ST
ORLANDO FL
32804-4019
US

IV. Provider business mailing address

316 GROVELAND ST
ORLANDO FL
32804-4019
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-9660
  • Fax: 407-896-9661
Mailing address:
  • Phone: 407-896-9660
  • Fax: 407-896-9661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME 98834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: