Provider Demographics
NPI:1467181933
Name:OFOMA, CHIEDOZIE MAX (MD)
Entity Type:Individual
Prefix:
First Name:CHIEDOZIE
Middle Name:MAX
Last Name:OFOMA
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 1:169 CROSS RAIL LN
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3942
Mailing Address - Country:US
Mailing Address - Phone:951-310-7478
Mailing Address - Fax:
Practice Address - Street 1:121 BUNTIN ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1320
Practice Address - Country:US
Practice Address - Phone:812-885-3228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program