Healthcare Provider Details

I. General information

NPI: 1386873404
Provider Name (Legal Business Name): IFECHI ANYADIOHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2009
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E. MADISON AVE SUITE 402
MANKATO MN
56001-5473
US

IV. Provider business mailing address

1400 E. MADISON AVE SUITE 402
MANKATO MN
56001-5473
US

V. Phone/Fax

Practice location:
  • Phone: 507-625-7246
  • Fax:
Mailing address:
  • Phone: 507-625-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number55220-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberTP107561
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: