Basic Information
| Provider Information | |||||||||
| NPI: | 1629026018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ONONYE | ||||||||
| FirstName: | CHUBA | ||||||||
| MiddleName: | BOSA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6642 E BASELINE RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852064436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802187800 | ||||||||
| FaxNumber: | 4809122399 | ||||||||
| Practice Location | |||||||||
| Address1: | 1917 SOUTH CRISMON ROAD | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4806107100 | ||||||||
| FaxNumber: | 4806107115 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 05/31/2018 | ||||||||
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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 | 23372 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 341678 | 05 | AZ | MEDICAID |