Healthcare Provider Details

I. General information

NPI: 1952666257
Provider Name (Legal Business Name): CHIKA AMUCHE KATHRYN EZIGBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHIKA UBAH M.D

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B3
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8000
  • Fax:
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.130088
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01084430A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35130088
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: