Provider Demographics
NPI:1720438187
Name:UDOH, INIMFON (MD)
Entity type:Individual
Prefix:
First Name:INIMFON
Middle Name:
Last Name:UDOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:INIMFON
Other - Middle Name:
Other - Last Name:UDOH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:YNHH NORTHEAST MEDICAL GROUP FAMILY MEDICINE
Mailing Address - Street 2:2 SANDY DESERT RD.
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382
Mailing Address - Country:US
Mailing Address - Phone:860-464-3800
Mailing Address - Fax:860-464-3801
Practice Address - Street 1:1200 PORT ARTHUR RD
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-1137
Practice Address - Country:US
Practice Address - Phone:715-532-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71408207P00000X
CT077374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine