Basic Information
| Provider Information | |||||||||
| NPI: | 1780004572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBU | ||||||||
| FirstName: | FIDELIS | ||||||||
| MiddleName: | IKECHUKWU | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 313 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197207883 | ||||||||
| FaxNumber: | 4197207895 | ||||||||
| Practice Location | |||||||||
| Address1: | 2213 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436201402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192514554 | ||||||||
| FaxNumber: | 4192516795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 10/20/2017 | ||||||||
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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 | 35.131496 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.