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1962296301 NPI number — IKPONMWOSA JUDE OGIEUHI M.D

NPI Number: 1962296301
Health Care Provider/Practitioner: IKPONMWOSA JUDE OGIEUHI M.D

Information about “1962296301” NPI (IKPONMWOSA JUDE OGIEUHI M.D) exists in 1962296301 in HTML format HTML  |  1962296301 in plain Text format TXT  |  1962296301 in PDF (Portable Document Format) PDF  |  1962296301 in an XML format XML  formats.

NPI Number : 1962296301 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962296301",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "OGIEUHI",
    "FirstName": "IKPONMWOSA",
    "MiddleName": "JUDE",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "M.D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4201 MEDICAL CENTER DRIVER",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MCHENRY",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60050",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "815-403-3905",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4201 MEDICAL CENTER DRIVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MCHENRY",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60050",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "815-759-4726",
    "PracticeLocationAddressFaxNumber": "815-759-8255",
    "EnumerationDate": "04/09/2025",
    "LastUpdateDate": "01/02/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "12/22/2025",
    "NPIReactivationDate": "01/02/2026",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207R00000X",
        "TaxonomyName": "Internal Medicine Physician",
        "LicenseNumber": "125086638",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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