MEDICARE: DR. IGWEBUIKE ONYEKABA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	039650	GA
2	208D00000X	General Practice Physician	039650	GA
3	207Q00000X	Family Medicine Physician	039650	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01045490A	OTHER	IN	INDIANA LICENSE
2	198714	OTHER	NY	NEW YORK LICENSE
3	01045490B	OTHER	IN	CSR
4	25MA06176700	OTHER	NJ	NEW JERSEY LICENSE

General Provider Information

NPI Number	:	1699721605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IGWEBUIKE ONYEKABA MD

Provider Business Mailing Address
First Line	:	PO BOX 957598
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30095-9527
Country	:	US
Telephone Number	:	470-355-2340
Fax Number	:	470-355-2347

Provider Business Practice Location Address
First Line	:	3375 MEMORIAL DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-2706
Country	:	US
Telephone Number	:	470-355-2340
Fax Number	:	470-355-2347

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	06/14/2023

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Directions to “ DR. IGWEBUIKE ONYEKABA MD” Practice Location

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