Healthcare Provider Details

I. General information

NPI: 1740446863
Provider Name (Legal Business Name): UJOR UDE EKO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: UJOR AGABI ONUGBA M.D

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11109 PARKVIEW PLAZA DR
FORT WAYNE IN
46845-1701
US

IV. Provider business mailing address

3814 GRANT ST
GARY IN
46408-2150
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-2020
  • Fax: 260-266-2009
Mailing address:
  • Phone: 219-397-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01065548A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: