MEDICARE: DR. CHIOMA EBELE OGBUEFI 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	174400000X	Specialist	15600R	LA

General Provider Information

NPI Number	:	1700821881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHIOMA EBELE OGBUEFI MD

Provider Business Mailing Address
First Line	:	4560 NORTH BLVD
Second Line	:	SUITE 108
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-201-0751
Fax Number	:	225-706-0173

Provider Business Practice Location Address
First Line	:	4560 NORTH BLVD
Second Line	:	SUITE 108
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-4043
Country	:	US
Telephone Number	:	225-201-0751
Fax Number	:	225-706-0173

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	04/04/2011

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