Basic Information
| Provider Information | |||||||||
| NPI: | 1255728747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IFEDILI | ||||||||
| FirstName: | IKECHUKWU | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9617 GRAYS SONG DR | ||||||||
| Address2: | |||||||||
| City: | CORDOVA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380187752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233913998 | ||||||||
| FaxNumber: | 8779914816 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIVERSITY OF TENNESSEE 910 MADISON AVE | ||||||||
| Address2: | SUITE 1031 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014485814 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2015 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | MD0000058373 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.