Healthcare Provider Details

I. General information

NPI: 1518083872
Provider Name (Legal Business Name): OBIAGERI THELMA EKEH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 W CHARLESTON BLVD 402
LAS VEGAS NV
89102-2227
US

IV. Provider business mailing address

1701 W CHARLESTON BLVD 215
LAS VEGAS NV
89102-2325
US

V. Phone/Fax

Practice location:
  • Phone: 702-671-2345
  • Fax: 702-671-2233
Mailing address:
  • Phone: 702-671-2355
  • Fax: 702-382-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13139
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number13139
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: