Basic Information
| Provider Information | |||||||||
| NPI: | 1235103102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UCHE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | OBINNA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 W MONROE ST STE 1200 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606032420 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6824 HARRISBURG RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282273389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048706014 | ||||||||
| FaxNumber: | 7047616886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2016-02140 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35086388 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0824228 | 05 | OH | MEDICAID | 2613845 | 05 | OH | MEDICAID | 000000568381 | 01 | OH | ANTHEM | OTHER | 01403 | 01 | OH | PARAMOUNT | OTHER | 603271 | 01 | OH | BUCKEYE COMMUNITY HEALTH | OTHER | 0274457 | 05 | OH | MEDICAID |