Provider Demographics
NPI:1295623460
Name:ABIANDU, ONOME MIRIAM
Entity type:Individual
Prefix:
First Name:ONOME
Middle Name:MIRIAM
Last Name:ABIANDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MEMORIAL DR
Mailing Address - Street 2:BUILDING B, SUITE 115
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6705
Mailing Address - Country:US
Mailing Address - Phone:618-463-5905
Mailing Address - Fax:
Practice Address - Street 1:4 MEMORIAL DR
Practice Address - Street 2:BUILDING B, SUITE 210
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002
Practice Address - Country:US
Practice Address - Phone:618-463-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.087001207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine