Provider Demographics
NPI:1174752554
Name:ILONZE, ONYEDIKA JOHN (MD)
Entity type:Individual
Prefix:
First Name:ONYEDIKA
Middle Name:JOHN
Last Name:ILONZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N. SENATE BLVD
Practice Address - Street 2:SUITE 2000
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-962-9700
Practice Address - Fax:317-962-9657
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084377A207R00000X, 207RA0001X, 207RC0000X
NC2012-01373207R00000X, 208M00000X
ARE-11428207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300040994Medicaid
IN000001418806OtherANTHEM PTAN
IN000001422091OtherANTHEM PTAN