Provider Demographics
NPI:1275781924
Name:JOHNSON-OGBUNEKE, GLADYS IKONNAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:IKONNAYA
Last Name:JOHNSON-OGBUNEKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GLADYS
Other - Middle Name:NGOZI
Other - Last Name:JOHNSON-OGBUNEKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD FRCS M SC ORTH
Mailing Address - Street 1:818 E MADISON ST
Mailing Address - Street 2:APT F
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1080
Mailing Address - Country:US
Mailing Address - Phone:502-749-6568
Mailing Address - Fax:
Practice Address - Street 1:818 E MADISON ST
Practice Address - Street 2:APT F
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1080
Practice Address - Country:US
Practice Address - Phone:502-749-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-07
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYFT430390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program