Provider Demographics
NPI:1578132981
Name:OGBUE, OLISAEMEKA DILIBE
Entity Type:Individual
Prefix:
First Name:OLISAEMEKA
Middle Name:DILIBE
Last Name:OGBUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:OLISA
Other - Middle Name:
Other - Last Name:OGBUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:FAIRVIEW HOSPITAL
Mailing Address - Street 2:18101 LORAIN AVE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111
Mailing Address - Country:US
Mailing Address - Phone:216-476-7000
Mailing Address - Fax:
Practice Address - Street 1:FAIRVIEW HOSPITAL
Practice Address - Street 2:18101 LORAIN AVE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111
Practice Address - Country:US
Practice Address - Phone:216-476-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2022-12-19
Deactivation Date:2022-12-07
Deactivation Code:
Reactivation Date:2022-12-19
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program