Provider Demographics
NPI:1972679355
Name:EGBUJIOBI, LEONARD C (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:C
Last Name:EGBUJIOBI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1905 E. HUEBBE PARKWAY
Mailing Address - Street 2:BELOIT HEALTH SYSTEM INC
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-1842
Mailing Address - Country:US
Mailing Address - Phone:608-364-2200
Mailing Address - Fax:608-363-7377
Practice Address - Street 1:1969 WEST HART ROAD
Practice Address - Street 2:BELOIT MEMORIAL HOSPITAL
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-364-2200
Practice Address - Fax:608-363-7377
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-10-19
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Provider Licenses
StateLicense IDTaxonomies
WI30790-020207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
10798OtherDEAN HEALTH PLAN
WI1972679355Medicaid
E44023Medicare UPIN