Healthcare Provider Details

I. General information

NPI: 1578141149
Provider Name (Legal Business Name): CHUKWUNONYE ONYEKA OGBUJI MD, B.SC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 E NORRIS DR
OTTAWA IL
61350-3681
US

IV. Provider business mailing address

1614 E NORRIS DR
OTTAWA IL
61350-3681
US

V. Phone/Fax

Practice location:
  • Phone: 815-433-1010
  • Fax:
Mailing address:
  • Phone: 815-433-1010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036168429
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: