Individual provider Active NPI

Ikenna Ifearulundu

  • Surgery Physician
  • New Orleans, LA
National Provider Identifier
1508449927
Registry record updated Jul 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
2618105 Issued in LA
Practice address
433 Bolivar St
New Orleans, LA 70112-7021
Phone
(504) 568-4808
NPI assigned
May 3, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Surgery Physician 208600000X 2618105 LA Primary

Addresses

Primary practice location

433 Bolivar St
New Orleans, LA 70112-7021

Mailing address

600 S Paulina St Ste 403
Chicago, IL 60612-3806

Other practice location 1

600 S Paulina St Ste 403
Chicago, IL 60612-3806
Phone (312) 942-7100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230522000702 LA Order and Referring Only - General SurgeryPractitioner - General Surgery 6103282991

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2618105LAMDSurgery Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1508449927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S PAULINA ST STE 403",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 BOLIVAR ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701127021",
            "telephone_number": "504-568-4808"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 S Paulina St Ste 403",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606123806",
            "country_code": "US",
            "telephone_number": "312-942-7100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IFEARULUNDU",
        "first_name": "IKENNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-03",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "2618105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Orleans, LA

Sources for this page

Verify at the official NPI Registry.