Provider Demographics
NPI:1023062684
Name:OTUBU-SCIPIO, ORITSETIMEYIN E (MD)
Entity type:Individual
Prefix:
First Name:ORITSETIMEYIN
Middle Name:E
Last Name:OTUBU-SCIPIO
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 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:14555 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-4494
Practice Address - Country:US
Practice Address - Phone:844-284-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI102411-875207Q00000X
TXT5422207Q00000X
MO2022011593207Q00000X
IN01087389A207Q00000X
CT65342207Q00000X
OH35.139913207Q00000X
VA0101265021207Q00000X
NC2018-01735207Q00000X
KY51978207Q00000X
MN70814207Q00000X
SC19570207Q00000X
IL036174163207Q00000X
CAC159878207Q00000X
FLME146470207Q00000X
PAMD466228207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911258Medicaid
WI100301311Medicaid
SC197500Medicaid
SCG952035121Medicare PIN
SCG952036084Medicare PIN
SC197500Medicaid