Healthcare Provider Details

I. General information

NPI: 1629065131
Provider Name (Legal Business Name): UYI-OGHOSA IDEMUDIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

IV. Provider business mailing address

222 MEDICAL CIR
MOREHEAD KY
40351-1179
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-6500
  • Fax: 606-783-6878
Mailing address:
  • Phone: 606-783-6500
  • Fax: 606-783-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD477800
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME122009
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number41633
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: