Organization
PATRICK IFEDIBA MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK EMEKA IFEDIBA M.D. (DIRECTOR)
(205) 929-0565
Entity
Organization
Contact information
Practice address
1300 BESSEMER RD, BIRMINGHAM, AL 35208-4326
(205) 929-0565
(205) 929-0564
Mailing address
PO BOX 59472, BIRMINGHAM, AL 35259-9472
(205) 929-0565
(205) 929-0564
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19014
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051554814
—
AL
01
—
51000499
BLUE CROSS
AL
Enumeration date
10/30/2007
Last updated
07/19/2010
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