Basic Information
| Provider Information | |||||||||
| NPI: | 1962714600 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UGONABO | ||||||||
| FirstName: | IFEOMA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | OKAFOR | ||||||||
| OtherFirstName: | IFEOMA | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 1000, DEPT 960 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381480001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017589900 | ||||||||
| FaxNumber: | 9017522335 | ||||||||
| Practice Location | |||||||||
| Address1: | 1211 UNION AVE STE 965 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014358550 | ||||||||
| FaxNumber: | 9014780781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2010 | ||||||||
| LastUpdateDate: | 12/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 61328 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301097106 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 60179 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.