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General NPI Number Information
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NPI Number | 1427165109
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Entity Type | Individual
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Provider Name | IFEYINWA ILECHUKWU MD
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Gender | Female
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 10350 W 9 MILE RD
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City | OAK PARK
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State | MI
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Zip | 48237-2913
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Country | US
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Telephone | 248-541-6630
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Fax | 248-541-6631
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Provider Business Mailing Address
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Address Line | 10350 W 9 MILE RD
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City | OAK PARK
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State | MI
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Zip | 48237-2913
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Country | US
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Telephone | 248-541-6630
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Fax | 248-541-6631
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301072967
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License Number State | MI
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