MEDICARE: DR. OBIAGERI THELMA EKEH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	13139	NV
2	2080P0203X	Pediatric Critical Care Medicine Physician	13139	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518083872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OBIAGERI THELMA EKEH MD

Provider Business Mailing Address
First Line	:	1701 W CHARLESTON BLVD
Second Line	:	215
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2325
Country	:	US
Telephone Number	:	702-671-2355
Fax Number	:	702-382-5388

Provider Business Practice Location Address
First Line	:	2040 W CHARLESTON BLVD
Second Line	:	402
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2227
Country	:	US
Telephone Number	:	702-671-2345
Fax Number	:	702-671-2233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	07/02/2013

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