Provider Demographics
NPI:1972692366
Name:OKAFOR, IFEANYICHUKWU OBIORA (MD)
Entity type:Individual
Prefix:
First Name:IFEANYICHUKWU
Middle Name:OBIORA
Last Name:OKAFOR
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 1:105 DAVE WARLICK DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4411
Mailing Address - Country:US
Mailing Address - Phone:704-748-9949
Mailing Address - Fax:704-748-2345
Practice Address - Street 1:105 DAVE WARLICK DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4411
Practice Address - Country:US
Practice Address - Phone:704-748-9949
Practice Address - Fax:704-748-2345
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200150261QP2300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132W6Medicaid
NC89132W6Medicaid
NC2330167Medicare PIN