Healthcare Provider Details

I. General information

NPI: 1861844201
Provider Name (Legal Business Name): OBINNA VICTOR OBIEKEZIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

2568 GREENLEFE DR
BEAVERCREEK OH
45431-8600
US

V. Phone/Fax

Practice location:
  • Phone: 216-861-6200
  • Fax: 847-723-2210
Mailing address:
  • Phone: 832-288-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.134912
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036.163331
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036.163331
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: