Healthcare Provider Details

I. General information

NPI: 1285122861
Provider Name (Legal Business Name): ONYEDIKA VICTOR UMEANAETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MCMILLAN RD
WEST MONROE LA
71291-5327
US

IV. Provider business mailing address

2222 GRAYCLIFF DR APT 217
DALLAS TX
75228-7222
US

V. Phone/Fax

Practice location:
  • Phone: 318-329-4200
  • Fax:
Mailing address:
  • Phone: 929-204-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number56515
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberU2028
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number328317
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: