Provider Demographics
NPI:1578582714
Name:UDEOZO, OBIORA I (MD)
Entity Type:Individual
Prefix:DR
First Name:OBIORA
Middle Name:I
Last Name:UDEOZO
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 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-583-6000
Mailing Address - Fax:
Practice Address - Street 1:1447 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:989-583-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036168162207RC0200X
TXP1941207RN0300X, 207RC0200X
MI4301081531207R00000X, 207RC0200X
MN51299207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX295741702Medicaid
TX295741703Medicaid
MNENROLLEDMedicaid
TX295741701Medicaid
MI4301081531OtherSTATE LICENSE
TX295741701Medicaid
TX319872YNAQMedicare PIN
MIPENDINGMedicare UPIN
MNENROLLEDMedicaid
MN810000187Medicare PIN