Provider Demographics
NPI:1861844201
Name:OBIEKEZIE, OBINNA VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:OBINNA
Middle Name:VICTOR
Last Name:OBIEKEZIE
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 1:2568 GREENLEFE DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-8600
Mailing Address - Country:US
Mailing Address - Phone:832-288-7885
Mailing Address - Fax:
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:847-723-2210
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134912207R00000X
IL036.163331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine