Provider Demographics
NPI:1215249156
Name:IFEDIORA, NNAMDI KENECHUKWU (MD)
Entity type:Individual
Prefix:DR
First Name:NNAMDI
Middle Name:KENECHUKWU
Last Name:IFEDIORA
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 1:414 E 9TH ST
Mailing Address - Street 2:7
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-6402
Mailing Address - Country:US
Mailing Address - Phone:870-718-1236
Mailing Address - Fax:
Practice Address - Street 1:414 E 9TH ST
Practice Address - Street 2:7
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202-6402
Practice Address - Country:US
Practice Address - Phone:870-718-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3965207R00000X
ARE3965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE-3965OtherNONE