Provider Demographics
NPI:1174672026
Name:IKEZUAGU, OJIAKU BALEWA (MD)
Entity Type:Individual
Prefix:
First Name:OJIAKU
Middle Name:BALEWA
Last Name:IKEZUAGU
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 1:417 S EAST ST
Mailing Address - Street 2:PO BOX 305
Mailing Address - City:CORYDON
Mailing Address - State:IA
Mailing Address - Zip Code:50060-0305
Mailing Address - Country:US
Mailing Address - Phone:641-872-2063
Mailing Address - Fax:641-872-2070
Practice Address - Street 1:417 S EAST ST
Practice Address - Street 2:SUITE #100
Practice Address - City:CORYDON
Practice Address - State:IA
Practice Address - Zip Code:50060-1860
Practice Address - Country:US
Practice Address - Phone:641-872-2063
Practice Address - Fax:641-872-2070
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA40468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine