Provider Demographics
NPI:1215169974
Name:IWUCHUKWU, IFEANYI OBIANYO (MD)
Entity type:Individual
Prefix:
First Name:IFEANYI
Middle Name:OBIANYO
Last Name:IWUCHUKWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 NW 14TH ST FL 13
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2107
Mailing Address - Country:US
Mailing Address - Phone:305-243-3100
Mailing Address - Fax:305-243-8071
Practice Address - Street 1:2801 NW 79TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1174
Practice Address - Country:US
Practice Address - Phone:786-466-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2058422084N0400X
NC2010-003342084N0400X
VA01012441592084N0400X
WI1003782084N0400X
RIMD189152084N0400X
SC393142084N0400X
IL0361234622084N0400X
FLME1555232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00277248Medicaid
SC393149Medicaid
LA2317164Medicaid
FL113881400Medicaid
MS00277248Medicaid
LA262444YH3UMedicare PIN