Provider Demographics
NPI:1255339925
Name:ONUIGBO, ANTHONY A (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:A
Last Name:ONUIGBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 E SAN MARNAN DR STE 1
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:227 E SAN MARNAN DR
Practice Address - Street 2:STE 1
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5829
Practice Address - Country:US
Practice Address - Phone:319-486-1731
Practice Address - Fax:319-300-4055
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34017207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0144OtherJOHN DEERE HEALTH CARE
IA0229823Medicaid
160052176OtherRAILROAD MEDICARE
26246OtherWELLMARK
IA0229823Medicaid