Provider Demographics
NPI:1639342363
Name:OBIAJA, KENNETH CHIEDU (MD , MPH)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHIEDU
Last Name:OBIAJA
Suffix:
Gender:M
Credentials:MD , MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2995 DREW ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-3012
Mailing Address - Country:US
Mailing Address - Phone:727-315-7496
Mailing Address - Fax:
Practice Address - Street 1:5089 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1326
Practice Address - Country:US
Practice Address - Phone:352-753-0606
Practice Address - Fax:352-365-1003
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448717207Q00000X
FLME108204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFD956WMedicare PIN