Provider Demographics
NPI:1811156730
Name:OBIH, IKECHUKWU JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:IKECHUKWU
Middle Name:JOHN
Last Name:OBIH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1700 BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2517
Mailing Address - Country:US
Mailing Address - Phone:512-430-6412
Mailing Address - Fax:512-446-0084
Practice Address - Street 1:1700 BRAZOS AVE
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567-2517
Practice Address - Country:US
Practice Address - Phone:512-430-6412
Practice Address - Fax:512-446-0084
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPGY.1.LSUN-NEUR2084N0400X
LAMD 2041442084N0600X
TXP89632084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology