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General NPI Number Information
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NPI Number | 1386873404
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Entity Type | Individual
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Provider Name | IFECHI ANYADIOHA MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2009
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1400 E. MADISON AVE SUITE 402
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City | MANKATO
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State | MN
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Zip | 56001-5473
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Country | US
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Telephone | 507-625-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E. MADISON AVE SUITE 402
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City | MANKATO
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State | MN
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Zip | 56001-5473
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Country | US
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Telephone | 507-625-7246
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 55220-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | TP107561
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License Number State | MN
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