Healthcare Provider Details

I. General information

NPI: 1477717080
Provider Name (Legal Business Name): MILTON OLUDHE OCHIENG' M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2008
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 BROADWAY ST
QUINCY IL
62301-2719
US

IV. Provider business mailing address

927 BROADWAY ST STE 300
QUINCY IL
62301-2728
US

V. Phone/Fax

Practice location:
  • Phone: 217-214-6230
  • Fax: 217-214-5854
Mailing address:
  • Phone: 217-214-6231
  • Fax: 217-214-5854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2014012514
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: