Provider Demographics
NPI:1730321985
Name:OSUJI, OBI UGOCHUKWU (MD)
Entity Type:Individual
Prefix:DR
First Name:OBI
Middle Name:UGOCHUKWU
Last Name:OSUJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OBINWANNE
Other - Middle Name:UGOCHUKWU
Other - Last Name:OSUJI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2540 N GALLOWAY AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4814
Mailing Address - Country:US
Mailing Address - Phone:972-863-9828
Mailing Address - Fax:
Practice Address - Street 1:2540 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6306
Practice Address - Country:US
Practice Address - Phone:972-863-9828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD24208207X00000X
GA077281207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC351381Medicaid