Provider Demographics
NPI:1033209267
Name:ONVEJIAKA, DEBRA RUTH (DPM)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:RUTH
Last Name:ONVEJIAKA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:RUTH
Other - Last Name:DELBUSTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:857 TAM OSHANTER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440
Mailing Address - Country:US
Mailing Address - Phone:630-972-9207
Mailing Address - Fax:
Practice Address - Street 1:406 WEST BOUGHTON ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-972-1006
Practice Address - Fax:630-759-8900
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009920148OtherBLUE CROSS BLUE SHIELD
IL205957Medicare ID - Type Unspecified
IL0009920148OtherBLUE CROSS BLUE SHIELD