Healthcare Provider Details

I. General information

NPI: 1659435204
Provider Name (Legal Business Name): IKECHUKWU C ONYEKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S COLUMBIA RD - ALTRU HOSPITAL
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-5000
  • Fax: 701-780-1942
Mailing address:
  • Phone: 701-780-1891
  • Fax: 701-780-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49585
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number49585
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9616
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: