Provider Demographics
NPI:1629065131
Name:IDEMUDIA, UYI-OGHOSA (MD)
Entity type:Individual
Prefix:DR
First Name:UYI-OGHOSA
Middle Name:
Last Name:IDEMUDIA
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 1:222 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1179
Mailing Address - Country:US
Mailing Address - Phone:606-783-6500
Mailing Address - Fax:606-783-6878
Practice Address - Street 1:222 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-783-6500
Practice Address - Fax:606-783-6878
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD477800208M00000X
FLME122009208M00000X
KY41633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41633OtherKENTUCKY MEDICAL LICENSE
KY7100036960Medicaid
FLME122009OtherSTATE MEDICAL LICENSE
KY3319274Medicare PIN
FLME122009OtherSTATE MEDICAL LICENSE