=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942874136
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEZIAH EZEEMWENGHIAN AIBANGBEE MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2021
-----------------------------------------------------
Last Update Date | 07/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9228 S MINGO RD STE 200
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74133-5722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-579-2981
-----------------------------------------------------
Fax | 918-579-1262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 955 MAIN ST STE 7230
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14203-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-961-6955
-----------------------------------------------------
Fax | 716-862-6304
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QS1201X
-----------------------------------------------------
Taxonomy Name | Sleep Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 036166842
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------