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General NPI Number Information
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NPI Number | 1790954352
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Entity Type | Individual
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Provider Name | OBINNA CHUKWUDI IGWILO M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 7300 S RAEFORD RD RM 2528
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-6162
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Country | US
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Telephone | 910-475-6373
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87126
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-7126
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Country | US
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Telephone | 910-426-2224
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Fax | 910-826-2228
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 200100381
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License Number State | NC
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