Healthcare Provider Details

I. General information

NPI: 1710119771
Provider Name (Legal Business Name): NELSON A. OBIKWU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HARRISON ST SUITE N
BATESVILLE AR
72501-7316
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD.
CORAL GABLES FL
33146
US

V. Phone/Fax

Practice location:
  • Phone: 870-262-2200
  • Fax: 870-262-2210
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE6211
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME115138
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME115138
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: