Healthcare Provider Details

I. General information

NPI: 1245807544
Provider Name (Legal Business Name): CHUKWUDUBEM C OBIANAGHA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

410 W 10TH AVE
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-9299
  • Fax:
Mailing address:
  • Phone: 614-293-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number58.032339
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: