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General NPI Number Information
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NPI Number | 1881270627
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Entity Type | Individual
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Provider Name | BRYAN ANOCHILI IKEUDENTA MD
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Gender | Male
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 1000 MINERAL POINT AVE
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City | JANESVILLE
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State | WI
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Zip | 53548-2940
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Country | US
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Telephone | 608-756-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 7702 N ALPINE RD
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City | LOVES PARK
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State | IL
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Zip | 61111-3107
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Country | US
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Telephone | 346-779-9821
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 125078130
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 79475
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 83666-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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