Healthcare Provider Details

I. General information

NPI: 1992152094
Provider Name (Legal Business Name): ODUCHE R IGBOECHI M.D., M.P.H., M.B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 514
ORLANDO FL
32804-4674
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 514
ORLANDO FL
32804-4674
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5687
  • Fax:
Mailing address:
  • Phone: 407-303-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberD0094550
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberME163657
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME163657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: