Provider Demographics
NPI:1386873404
Name:ANYADIOHA, IFECHI (MD)
Entity type:Individual
Prefix:
First Name:IFECHI
Middle Name:
Last Name:ANYADIOHA
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 1:1400 E. MADISON AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5473
Mailing Address - Country:US
Mailing Address - Phone:507-625-7246
Mailing Address - Fax:
Practice Address - Street 1:1400 E. MADISON AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5473
Practice Address - Country:US
Practice Address - Phone:507-625-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55220-20207LP2900X
MNTP107561208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine