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NPI Code Detail

MEDICARE: DR. OBINNA IKE NDUBUIZU M.D., PH.D.

MEDICARE: DR. OBINNA IKE NDUBUIZU M.D., PH.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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1902217060
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OBINNA IKE NDUBUIZU M.D., PH.D.
Provider Business Mailing Address
First Line : 9512 PARK HEIGHTS AVE
Second Line :
City : GARFIELD HEIGHTS
State : OH
Zip : 44125-2347
Country : US
Telephone Number : 443-804-7739
Fax Number :
Provider Business Practice Location Address
First Line : 11100 EUCLID AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44106-1716
Country : US
Telephone Number : 216-844-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2014
Last Update Date : 05/12/2014

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