MEDICARE: ONYEKACHI IFUDU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	176905	NY
2	207RN0300X	Nephrology Physician	176905	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073551966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONYEKACHI IFUDU MD

Provider Business Mailing Address
First Line	:	28 LYNWOOD DR
Second Line	:
City	:	WESTBURY
State	:	NY
Zip	:	11590-1132
Country	:	US
Telephone Number	:	516-816-4040
Fax Number	:	718-258-9273

Provider Business Practice Location Address
First Line	:	1915 OCEAN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6801
Country	:	US
Telephone Number	:	718-258-7700
Fax Number	:	718-258-9273

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	01/19/2010

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Directions to “ ONYEKACHI IFUDU MD” Practice Location

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