Basic Information
| Provider Information | |||||||||
| NPI: | 1194089870 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | OBI | ||||||||
| FirstName: | NGOZI | ||||||||
| MiddleName: | UCHENNA | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | NORTH HILLS HEALTH CENTER | ||||||||
| Address2: | W129 N7055 NORTHFIELD DRIVE | ||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622535150 | ||||||||
| FaxNumber: | 2622536058 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | CHEVERLY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207851189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016183776 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2012 | ||||||||
| LastUpdateDate: | 01/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2083X0100X | 21091-875 | WI | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 21091-875 | 05 | WI | MEDICAID |