MEDICARE: DR. IFEOMA STELLA IZUCHUKWU M.D, MPH, FACP

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	0101281324	VA
2	207R00000X	Internal Medicine Physician	D0095079	MD

General Provider Information

NPI Number	:	1811992738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IFEOMA STELLA IZUCHUKWU M.D, MPH, FACP

Provider Business Mailing Address
First Line	:	PO BOX 13042
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90295-4042
Country	:	US
Telephone Number	:	888-664-1121
Fax Number	:	310-362-0390

Provider Business Practice Location Address
First Line	:	9000 WOODYARD RD
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-4206
Country	:	US
Telephone Number	:	240-546-3428
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	03/12/2024

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