Provider Demographics
NPI:1699712448
Name:MUONEKE, VINCENT NNAEMEKA (MD)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:NNAEMEKA
Last Name:MUONEKE
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:PO BOX 97115
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98497-0115
Mailing Address - Country:US
Mailing Address - Phone:253-588-7911
Mailing Address - Fax:253-984-6774
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE280
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-248-6992
Practice Address - Fax:253-984-6774
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000279312086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0103941OtherLABOR & INDUSTRY
WA1094879Medicaid
WAMU7229OtherREGENCE
WAG000108215Medicare ID - Type Unspecified
WA1094879Medicaid