Provider Demographics
NPI:1063285393
Name:ANYAOGU, EMMANUEL I
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:I
Last Name:ANYAOGU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8906 177TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6670
Mailing Address - Country:US
Mailing Address - Phone:612-710-7804
Mailing Address - Fax:952-997-6109
Practice Address - Street 1:8906 177TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6670
Practice Address - Country:US
Practice Address - Phone:763-205-1702
Practice Address - Fax:763-205-1703
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN412101171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator