Provider Demographics
NPI:1144243247
Name:UGBOAJAH, REKIYATU LAWAL (MD)
Entity Type:Individual
Prefix:MRS
First Name:REKIYATU
Middle Name:LAWAL
Last Name:UGBOAJAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REKIYATU
Other - Middle Name:OHUNENE
Other - Last Name:LAWAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18601 ROYAL POINTE DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7492
Mailing Address - Country:US
Mailing Address - Phone:612-396-5100
Mailing Address - Fax:
Practice Address - Street 1:18601 ROYAL POINTE DRIVE
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-7492
Practice Address - Country:US
Practice Address - Phone:612-396-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39120207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNG79618Medicare UPIN