Organization
INDIAN RIVER REHABILITATION MEDICINE CLINIC P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. IHEONU USOUWA ORIAKU M.D. (PRESIDENT/ MEDICAL DIRECTOR)
(772) 643-4208
Entity
Organization
Contact information
Practice address
631 17TH STREET, VERO BEACH, FL 32960-5518
(772) 778-1603
(772) 231-8470
Mailing address
P O BOX 2692, VERO BEACH, FL 32961-2692
(772) 778-1603
(772) 231-8470
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME79198
FL
207Q00000X
Family Medicine Physician
ME79198
FL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
ME79198
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259802700
—
FL
01
—
49280
MEDICARE
FL
Enumeration date
10/21/2010
Last updated
11/22/2010
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