Individual
IFEANYICHUKWU ALEX ANOKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901
(618) 549-0721
(618) 529-0469
Mailing address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
(618) 529-0469
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036149293
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100230306
—
WI
01
—
218441
MULTI-SPECIALTY GROUP PTAN
IL
Enumeration date
07/21/2016
Last updated
08/16/2023
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