MEDICARE: IFEANYI CHRISTIAN OBIAKALUSI M.D

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1730074196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IFEANYI CHRISTIAN OBIAKALUSI M.D

Provider Business Mailing Address
First Line	:	MERCY ST. VINCENT MEDICAL CENTER
Second Line	:	2213 CHERRY ST.
City	:	TOLEDO
State	:	OH
Zip	:	43608
Country	:	US
Telephone Number	:	419-251-1860
Fax Number	:	419-251-2422

Provider Business Practice Location Address
First Line	:	MERCY ST. VINCENT MEDICAL CENTER
Second Line	:	2213 CHERRY ST.
City	:	TOLEDO
State	:	OH
Zip	:	43608
Country	:	US
Telephone Number	:	419-251-1860
Fax Number	:	419-251-2422

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	03/03/2026

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