Provider Demographics
NPI:1942874136
Name:AIBANGBEE, KEZIAH EZEEMWENGHIAN (MD)
Entity Type:Individual
Prefix:MS
First Name:KEZIAH
Middle Name:EZEEMWENGHIAN
Last Name:AIBANGBEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 N ALPINE RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111
Mailing Address - Country:US
Mailing Address - Phone:815-742-0892
Mailing Address - Fax:815-971-9795
Practice Address - Street 1:7702 N ALPINE RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111
Practice Address - Country:US
Practice Address - Phone:815-742-0892
Practice Address - Fax:815-971-9795
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2022-11-07
Deactivation Date:2022-10-27
Deactivation Code:
Reactivation Date:2022-11-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program