Healthcare Provider Details

I. General information

NPI: 1851438139
Provider Name (Legal Business Name): OBIANUJU OKOCHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E. 17TH AVE, AO1 8202 UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
AURORA CO
80045-0001
US

IV. Provider business mailing address

12631 EAST 17TH AVENUE AO18202
AURORA CO
80045
US

V. Phone/Fax

Practice location:
  • Phone: 303-724-1751
  • Fax:
Mailing address:
  • Phone: 303-724-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number46848
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: