Provider Demographics
NPI:1669855250
Name:OGWU, CHIEDU A (MD)
Entity Type:Individual
Prefix:
First Name:CHIEDU
Middle Name:A
Last Name:OGWU
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 1:2505 W BELT LINE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-1930
Mailing Address - Country:US
Mailing Address - Phone:972-230-8290
Mailing Address - Fax:972-230-8274
Practice Address - Street 1:2505 W BELT LINE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-1930
Practice Address - Country:US
Practice Address - Phone:972-230-8290
Practice Address - Fax:972-230-8274
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10054921207R00000X
TXR8251207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX400291701Medicaid