Provider Demographics
NPI:1457915431
Name:OBIOHA, OBIANUJU ADAMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:OBIANUJU
Middle Name:ADAMMA
Last Name:OBIOHA
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 1:125 S JEFFERSON ST UNIT 1208
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-3698
Mailing Address - Country:US
Mailing Address - Phone:301-503-2850
Mailing Address - Fax:
Practice Address - Street 1:1650 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3800
Practice Address - Country:US
Practice Address - Phone:312-942-5495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.075011207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty