Individual
IFEATU UCHENNA OTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1133 MEDICAL DR, TYLER, TX 75701-2130
(903) 595-5486
(903) 595-5128
Mailing address
1133 MEDICAL DR, TYLER, TX 75701-2130
(903) 595-5486
(903) 595-5128
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
34742
OK
207RN0300X
Nephrology Physician
35.086016
OH
207RN0300X
Nephrology Physician
7363
SD
207RN0300X
Nephrology Physician
Primary
N5305
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200280780 A
—
OK
05
—
2108011-01
—
TX
Enumeration date
03/14/2008
Last updated
05/04/2023
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