Basic Information
| Provider Information | |||||||||
| NPI: | 1750358586 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYIKA | ||||||||
| FirstName: | CHI-CHI | ||||||||
| MiddleName: | NWASINACHUKWU PHINA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MBBS | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | AYIKA | ||||||||
| OtherFirstName: | CHI CHI | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8170 33RD AVE S # 21110Q | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554254516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635874800 | ||||||||
| FaxNumber: | 7635874885 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 3RD ST NW | ||||||||
| Address2: | MAIL STOP 39400A | ||||||||
| City: | ELK RIVER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553301445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637126000 | ||||||||
| FaxNumber: | 7637126591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 07/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 46515 | MN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 871459200 | 05 | MN | MEDICAID |