Provider Demographics
NPI:1285965855
Name:OMENI, ALVAN CHIBUEZE (MD)
Entity type:Individual
Prefix:DR
First Name:ALVAN
Middle Name:CHIBUEZE
Last Name:OMENI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12700 SOUTHFORK RD STE 280
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3287
Mailing Address - Country:US
Mailing Address - Phone:314-892-6565
Mailing Address - Fax:314-892-4828
Practice Address - Street 1:12700 SOUTHFORK RD STE 280
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3287
Practice Address - Country:US
Practice Address - Phone:314-892-6565
Practice Address - Fax:314-892-4828
Is Sole Proprietor?:No
Enumeration Date:2010-01-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011039119208000000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics