MEDICARE: DR. IKECHUKWU ANTHONY IFEDILI 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	207RC0000X	Cardiovascular Disease Physician	MD0000058373	TN
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	MD0000058373	TN
4	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD0000058373	TN

General Provider Information

NPI Number	:	1255728747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IKECHUKWU ANTHONY IFEDILI MD

Provider Business Mailing Address
First Line	:	1211 UNION AVE STE 330
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6655
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 UNION AVE STE 400
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-6656
Country	:	US
Telephone Number	:	901-478-0650
Fax Number	:

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

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	11/19/2024

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