Healthcare Provider Details

I. General information

NPI: 1679495428
Provider Name (Legal Business Name): IKENNA EBERE OGBONNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

2301 PRIMROSE DR APT 6C
COLUMBIA MO
65202-1207
US

V. Phone/Fax

Practice location:
  • Phone: 573-277-9230
  • Fax:
Mailing address:
  • Phone: 573-277-9230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2026011320
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: