Healthcare Provider Details

I. General information

NPI: 1093095317
Provider Name (Legal Business Name): OBIAGELI IMMACULATA ESOTU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BJC SAINT PETERS DR STE 200
SAINT PETERS MO
63376-3386
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-916-9615
  • Fax: 636-916-9850
Mailing address:
  • Phone: 636-916-9615
  • Fax: 636-916-9850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003650A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125081291
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026030910
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: