MEDICARE: IKECHUKWU IFEANYI ONYEDIKA M.D.

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	207XP3100X	Pediatric Orthopaedic Surgery Physician	R1096	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R1096	OTHER	TX	TEXAS MEDICAL LICENSE

General Provider Information

NPI Number	:	1306008180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IKECHUKWU IFEANYI ONYEDIKA M.D.

Provider Business Mailing Address
First Line	:	4646 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6104
Country	:	US
Telephone Number	:	915-313-6300
Fax Number	:	915-521-2028

Provider Business Practice Location Address
First Line	:	4646 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6104
Country	:	US
Telephone Number	:	915-313-6300
Fax Number	:	915-521-2028

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

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	01/17/2017

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