Provider Demographics
NPI:1376517524
Name:OLOBIA, IGHO C (MD)
Entity Type:Individual
Prefix:
First Name:IGHO
Middle Name:C
Last Name:OLOBIA
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 1:541 W MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3628
Mailing Address - Country:US
Mailing Address - Phone:469-702-6633
Mailing Address - Fax:469-702-6636
Practice Address - Street 1:541 W MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057
Practice Address - Country:US
Practice Address - Phone:469-702-6633
Practice Address - Fax:469-702-6636
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040592001Medicaid
TX040592007Medicaid
TX040592001Medicaid
TX040592007Medicaid