Provider Demographics
NPI:1679033039
Name:EZIOLISA, OBIANUJU CHINONYE (DO)
Entity Type:Individual
Prefix:
First Name:OBIANUJU
Middle Name:CHINONYE
Last Name:EZIOLISA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:UJU
Other - Middle Name:
Other - Last Name:EZIOLISA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:ONE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-8091
Practice Address - Fax:573-884-1902
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT5883207P00000X
MO2023027333207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine