Provider Demographics
NPI:1003069766
Name:OPARA, IJEOMA NNODIM (MD)
Entity Type:Individual
Prefix:DR
First Name:IJEOMA
Middle Name:NNODIM
Last Name:OPARA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:400 MACK AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2136
Mailing Address - Country:US
Mailing Address - Phone:313-448-9006
Mailing Address - Fax:313-966-7305
Practice Address - Street 1:4201 ST. ANTOINE STE 6A & 6B
Practice Address - Street 2:GENERAL MEDICINE AMBULATORY PRACTICE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-1804
Practice Address - Country:US
Practice Address - Phone:313-745-4627
Practice Address - Fax:313-966-7305
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301092567208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics