Provider Demographics
NPI:1346001450
Name:EKUIBE, UCHENNA JOSEPH SR
Entity Type:Individual
Prefix:
First Name:UCHENNA
Middle Name:JOSEPH
Last Name:EKUIBE
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 E 141ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2304
Mailing Address - Country:US
Mailing Address - Phone:216-640-3557
Mailing Address - Fax:
Practice Address - Street 1:4418 E 141ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2304
Practice Address - Country:US
Practice Address - Phone:216-640-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health