Provider Demographics
NPI:1265465884
Name:OBISIKE, UCHE N (MD)
Entity Type:Individual
Prefix:
First Name:UCHE
Middle Name:N
Last Name:OBISIKE
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 1:1350 JACKIE RD SE STE 101
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1519
Mailing Address - Country:US
Mailing Address - Phone:505-892-7518
Mailing Address - Fax:
Practice Address - Street 1:1350 JACKIE RD SE STE 101
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1519
Practice Address - Country:US
Practice Address - Phone:505-892-7518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71854851Medicaid
NMP00339560OtherRAIL ROAD MEDICARE
NMNM001P72OtherBCBS
NM71854851Medicaid
NM10633001OtherAHCCCS