Provider Demographics
NPI:1700534286
Name:ILOABACHIE, OGUGUA (MD)
Entity Type:Individual
Prefix:DR
First Name:OGUGUA
Middle Name:
Last Name:ILOABACHIE
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:PO BOX 1233
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-1233
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:537 FREDERICK STREET
Practice Address - Street 2:
Practice Address - City:KITCHENER
Practice Address - State:ON
Practice Address - Zip Code:N2B 2A7
Practice Address - Country:CA
Practice Address - Phone:519-804-4190
Practice Address - Fax:519-340-6819
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine