Provider Demographics
NPI:1518128149
Name:EZEWUIRO, OBIAGELI CHINAKA (MD)
Entity Type:Individual
Prefix:DR
First Name:OBIAGELI
Middle Name:CHINAKA
Last Name:EZEWUIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OBIAGELI
Other - Middle Name:CHINAKA
Other - Last Name:NTUKOGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:7848 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1815
Practice Address - Country:US
Practice Address - Phone:915-599-1313
Practice Address - Fax:915-599-1701
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL11013729A207R00000X
IN01069645A207RH0003X
KYTP954207RX0202X
TXS6610207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX417903801Medicaid