Provider Demographics
NPI:1629026018
Name:ONONYE, CHUBA BOSA (MD)
Entity Type:Individual
Prefix:
First Name:CHUBA
Middle Name:BOSA
Last Name:ONONYE
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 1:6642 E BASELINE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4436
Mailing Address - Country:US
Mailing Address - Phone:480-218-7800
Mailing Address - Fax:480-912-2399
Practice Address - Street 1:1917 SOUTH CRISMON ROAD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-610-7100
Practice Address - Fax:480-610-7115
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341678Medicaid
AZ341678Medicaid
G25155Medicare UPIN