Provider Demographics
NPI:1710119771
Name:OBIKWU, NELSON A (MD)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:A
Last Name:OBIKWU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5955 PONCE DE LEON BLVD.
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-661-1515
Mailing Address - Fax:305-662-3723
Practice Address - Street 1:1700 HARRISON ST
Practice Address - Street 2:SUITE N
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7316
Practice Address - Country:US
Practice Address - Phone:870-262-2200
Practice Address - Fax:870-262-2210
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE6211208000000X
FLME115138208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE6211OtherLICENSE NUMBER