Organization
I D MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VITALIS C OKECHUKWU MD (OWNER OPERATOR)
(337) 407-1955
Entity
Organization
Contact information
Practice address
1119 PRUDHOMME CIR, OPELOUSAS, LA 70570-6544
(337) 407-1955
(337) 407-1956
Mailing address
1119 PRUDHOMME CIR, OPELOUSAS, LA 70570-6544
(337) 407-1955
(337) 407-1956
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
15601R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1 07409 8
—
LA
Enumeration date
07/23/2006
Last updated
08/22/2020
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