Healthcare Provider Details

I. General information

NPI: 1093490302
Provider Name (Legal Business Name): UCHECHUKWU OHIJIE OGBONNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 12/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 SOUTH CONGRESS AVENUE
ATLANTIS FL
33462
US

IV. Provider business mailing address

8 NUHU ALIYU CRESCENT
KADUNA KADUNA
800243
NG

V. Phone/Fax

Practice location:
  • Phone: 561-548-1711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: