Provider Demographics
NPI:1700853926
Name:UKETUI, OZOEMENAM IMMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:OZOEMENAM
Middle Name:IMMANUEL
Last Name:UKETUI
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 1:1905 19TH ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2502
Mailing Address - Country:US
Mailing Address - Phone:620-792-5700
Mailing Address - Fax:620-792-5742
Practice Address - Street 1:1905 19TH ST
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2502
Practice Address - Country:US
Practice Address - Phone:620-792-5700
Practice Address - Fax:620-792-5742
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6P76207Q00000X
KS0428643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100288780DMedicaid
MO203062153Medicaid
MO203062153Medicaid
F293000AMedicare ID - Type Unspecified
B42B39603OtherDEA
MO203062153Medicaid