Provider Demographics
NPI:1922689447
Name:OBI, OKECHUKWU JIDEOFOR (MD)
Entity Type:Individual
Prefix:
First Name:OKECHUKWU
Middle Name:JIDEOFOR
Last Name:OBI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:270 COPPERFIELD BLVD NE STE 202
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2441
Mailing Address - Country:US
Mailing Address - Phone:704-721-2060
Mailing Address - Fax:704-403-0470
Practice Address - Street 1:4315 PHYSICIANS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7431
Practice Address - Country:US
Practice Address - Phone:704-455-6521
Practice Address - Fax:704-455-3078
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
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Provider Licenses
StateLicense IDTaxonomies
NC303065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine