Healthcare Provider Details

I. General information

NPI: 1740700798
Provider Name (Legal Business Name): ILOABUEKE GABRIEL CHINEKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 E 2ND ST
CASPER WY
82609-4293
US

IV. Provider business mailing address

PO BOX 846266
LOS ANGELES CA
90084-6266
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-5433
  • Fax:
Mailing address:
  • Phone: 888-802-9885
  • Fax: 615-783-1082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number14952A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number14952A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: