Provider Demographics
NPI:1871750083
Name:IFEANYI, IFEYINWA CHINYELU (MD)
Entity type:Individual
Prefix:DR
First Name:IFEYINWA
Middle Name:CHINYELU
Last Name:IFEANYI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IFEYINWA
Other - Middle Name:CHINYELU
Other - Last Name:IFEANYI-PILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4009
Practice Address - Country:US
Practice Address - Phone:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3005207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DN728OtherBCBS
TX312129501Medicaid
TX312129501Medicaid