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General NPI Number Information
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NPI Number | 1386136794
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Entity Type | Individual
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Provider Name | IFEANYICHUKWU D,C ONUKOGU MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2018
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 4101 22ND PL
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City | LUBBOCK
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State | TX
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Zip | 79410-1121
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Country | US
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Telephone | 806-725-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 651 N 5TH ST
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City | NEWARK
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State | NJ
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Zip | 07107-2601
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Country | US
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Telephone | 862-588-9381
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 123456
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101281680
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | V2804
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License Number State | TX
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