Provider Demographics
NPI:1740446863
Name:EKO, UJOR UDE (MD)
Entity type:Individual
Prefix:
First Name:UJOR
Middle Name:UDE
Last Name:EKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:UJOR
Other - Middle Name:AGABI
Other - Last Name:ONUGBA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3814 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46408-2150
Mailing Address - Country:US
Mailing Address - Phone:219-397-1951
Mailing Address - Fax:
Practice Address - Street 1:11109 PARKVIEW PLAZA DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1701
Practice Address - Country:US
Practice Address - Phone:260-266-2020
Practice Address - Fax:260-266-2009
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065548A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine