Provider Demographics
NPI:1477933984
Name:ESOGA, KELECHI (MD)
Entity Type:Individual
Prefix:DR
First Name:KELECHI
Middle Name:
Last Name:ESOGA
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 1:8957 HUDSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667
Mailing Address - Country:US
Mailing Address - Phone:727-766-0000
Mailing Address - Fax:813-291-7260
Practice Address - Street 1:8957 HUDSON AVENUE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-766-0000
Practice Address - Fax:813-291-7260
Is Sole Proprietor?:No
Enumeration Date:2015-06-01
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN758208D00000X
PR19,069208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice