MEDICARE: DR. IKENNA I EGBUNA 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	207RG0100X	Gastroenterology Physician	01070397A	IN
2	207RG0100X	Gastroenterology Physician	P1638	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000750628	OTHER	IN	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	241127	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1598805574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IKENNA I EGBUNA M.D.

Provider Business Mailing Address
First Line	:	3270 JOE BATTLE BLVD
Second Line	:	245
City	:	EL PASO
State	:	TX
Zip	:	79938-2639
Country	:	US
Telephone Number	:	915-702-0165
Fax Number	:	915-702-0167

Provider Business Practice Location Address
First Line	:	3270 JOE BATTLE BLVD
Second Line	:	245
City	:	EL PASO
State	:	TX
Zip	:	79938-2639
Country	:	US
Telephone Number	:	915-702-0165
Fax Number	:	915-702-0167

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	03/07/2023

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Directions to “ DR. IKENNA I EGBUNA M.D.” Practice Location

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