Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 52245 | MN |
N | 111NI0900X | Internist | 52245 | MN |
Y | 2081P2900X | Pain Medicine | 52245 | MN |
NPI | 1104082171 |
---|---|
Provider Name | Dr. Obioma J. Igboko |
First Address | Duluth, MN 55805 |
Second Address | Duluth, MN 55805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 02/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104082171 | (05) | MN |
1104082171 | (05) | WI |