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GLEN EHICHEOYA ORIAIFO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
515 BAYOU ST, VINCENNES, IN 47591-1034
(812) 886-6800
(812) 886-6809
Mailing address
1160 E SAINT CLAIR ST, VINCENNES, IN 47591-4853
(812) 885-3106
(812) 885-8499

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
01083103A
IN
2084P0800X
Psychiatry Physician
Primary
01083103A
IN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01083103A
LICENSE
IN
01
01083103B
CSR
IN
05
300042757
IN
Enumeration date
05/03/2016
Last updated
09/25/2024
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