Basic Information
Provider Information
NPI: 1013538636
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EGIEBOR-AIWAN
FirstName: OYOYO
MiddleName: FRANCESS
NamePrefix: DR.
NameSuffix:  
Credential: MD, MPH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 319 E MADISON ST FL 3
Address2:  
City: SPRINGFIELD
State: IL
PostalCode: 627011035
CountryCode: US
TelephoneNumber: 2175458229
FaxNumber: 2175452275
Practice Location
Address1: 319 E MADISON ST FL 3
Address2:  
City: SPRINGFIELD
State: IL
PostalCode: 627011035
CountryCode: US
TelephoneNumber: 2175458229
FaxNumber: 2175452275
Other Information
ProviderEnumerationDate: 05/05/2020
LastUpdateDate: 05/05/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/05/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X125.075974ILY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


Home