Provider Demographics
NPI:1003656414
Name:OBIAJULU, KEN-LOUIS EMEKA
Entity type:Individual
Prefix:
First Name:KEN-LOUIS
Middle Name:EMEKA
Last Name:OBIAJULU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10504 LOUISVILLE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6048
Mailing Address - Country:US
Mailing Address - Phone:240-467-4022
Mailing Address - Fax:
Practice Address - Street 1:10504 LOUISVILLE LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-6048
Practice Address - Country:US
Practice Address - Phone:240-467-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator