Provider Demographics
NPI:1326676495
Name:ORUBU, EJIROGHENE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:EJIROGHENE
Middle Name:
Last Name:ORUBU
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:EJIROGHENE
Other - Middle Name:
Other - Last Name:AKPOYIBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MB,BS
Mailing Address - Street 1:17725 58TH CIR N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4621
Mailing Address - Country:US
Mailing Address - Phone:443-985-2746
Mailing Address - Fax:
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-624-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA61373927208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program