Provider Demographics
NPI:1083134704
Name:OBI, OKECHUKWU NWABUEZE (MBBS)
Entity Type:Individual
Prefix:DR
First Name:OKECHUKWU
Middle Name:NWABUEZE
Last Name:OBI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7788 GRACE CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4746
Mailing Address - Country:US
Mailing Address - Phone:270-320-3158
Mailing Address - Fax:
Practice Address - Street 1:2300 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2149
Practice Address - Country:US
Practice Address - Phone:702-724-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV24703207R00000X
IL125071151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine