Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01054231A | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 01054231A | IN |
NPI | 1134190713 |
---|---|
Provider Name | Dr. Oranu G Ibekie |
First Address | Merrillville, IN 46411-0746 |
Second Address | Merrillville, IN 46410-8900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 24/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200333030 | (05) | IN |
C174871 | CALIFORNIA STATE LICENSE (01) | CA |
H42123 | (02) | IN |