Basic Information
| Provider Information | |||||||||
| NPI: | 1578582714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UDEOZO | ||||||||
| FirstName: | OBIORA | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1447 N HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895836000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1447 N HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895836000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 10/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301081531 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0200X | 51299 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | P1941 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RN0300X | P1941 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RC0200X | 4301081531 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4301081531 | 01 | MI | STATE LICENSE | OTHER | ENROLLED | 05 | MN | MEDICAID | 295741701 | 05 | TX | MEDICAID | 295741702 | 05 | TX | MEDICAID | 295741703 | 05 | TX | MEDICAID |