Basic Information
| Provider Information | |||||||||
| NPI: | 1720243751 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANIGBOGU | ||||||||
| FirstName: | IFEYINWA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1022 | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294651022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435730499 | ||||||||
| FaxNumber: | 8435732463 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 PHYSICIANS DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435730499 | ||||||||
| FaxNumber: | 8435732463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2008 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036134126 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 2015-01318 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RN0300X | 52181 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.