Healthcare Provider Details

I. General information

NPI: 1376238741
Provider Name (Legal Business Name): CRYSTAL CHIZARAM OBI AZUIKE MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 CANAL ST # 8448
NEW ORLEANS LA
70112-2703
US

IV. Provider business mailing address

1440 CANAL ST # 8448
NEW ORLEANS LA
70112-2703
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-4272
  • Fax:
Mailing address:
  • Phone: 504-988-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number337212
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: