Provider Demographics
NPI:1124005418
Name:OGBARA, TAJUDEEN (MD)
Entity Type:Individual
Prefix:
First Name:TAJUDEEN
Middle Name:
Last Name:OGBARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9201 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2807
Mailing Address - Country:US
Mailing Address - Phone:219-836-2022
Mailing Address - Fax:219-836-0034
Practice Address - Street 1:2075 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1948
Practice Address - Country:US
Practice Address - Phone:219-659-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040726A207RI0200X
IL036085105207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN440002427OtherRR MEDICARE PTAN
IN200082460Medicaid
ILIL2507001Medicare PIN
F35436Medicare UPIN
ILL82507Medicare PIN
IN218150Medicare PIN
IN200082460Medicaid