Provider Demographics
NPI:1639342363
Name:OBIAJA, KENNETH CHIEDU (MD , MPH)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHIEDU
Last Name:OBIAJA
Suffix:
Gender:M
Credentials:MD , MPH
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Mailing Address - Street 1:511 MEDICAL PLAZA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7328
Mailing Address - Country:US
Mailing Address - Phone:352-728-6808
Mailing Address - Fax:352-728-1743
Practice Address - Street 1:201 LAGRANDE BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-1303
Practice Address - Country:US
Practice Address - Phone:352-753-0606
Practice Address - Fax:352-365-1003
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME108204207Q00000X
PAMD448717207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD956WMedicare PIN