Provider Demographics
NPI:1083679161
Name:ODENIGBO, LINDA EBELECHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:EBELECHUKWU
Last Name:ODENIGBO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:8638 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1051
Practice Address - Country:US
Practice Address - Phone:937-237-4945
Practice Address - Fax:937-237-4925
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078833O208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2215105Medicaid
370019768OtherMEDICARE RR
OHOD4057051Medicare PIN
370019768OtherMEDICARE RR