Basic Information
| Provider Information | |||||||||
| NPI: | 1760465421 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHIMEKA ANYANWOKE | ||||||||
| FirstName: | GERTRUDE | ||||||||
| MiddleName: | I. O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 583 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708210583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252896803 | ||||||||
| FaxNumber: | 2252896483 | ||||||||
| Practice Location | |||||||||
| Address1: | 3844 CONVENTION ST | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708063803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252896803 | ||||||||
| FaxNumber: | 2252896483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2005 | ||||||||
| LastUpdateDate: | 02/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 237866 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1355089 | 05 | LA | MEDICAID |