Provider Demographics
NPI:1659412591
Name:OZUMBA, OLUCHI (MD)
Entity Type:Individual
Prefix:DR
First Name:OLUCHI
Middle Name:
Last Name:OZUMBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 N MAIN ST UNIT 1386
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3293
Mailing Address - Country:US
Mailing Address - Phone:443-418-4667
Mailing Address - Fax:859-252-3073
Practice Address - Street 1:601 S CLAY ST STE 104
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5771
Practice Address - Country:US
Practice Address - Phone:443-418-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435554207LP2900X, 208VP0014X
KY47813208VP0000X
TXQ0682207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100317560Medicaid
KY7100317560Medicaid