Provider Demographics
NPI:1316168743
Name:MONEME, OBINNA IFEANYICHUKWU (MD)
Entity type:Individual
Prefix:DR
First Name:OBINNA
Middle Name:IFEANYICHUKWU
Last Name:MONEME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1480 W LANE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3919
Practice Address - Country:US
Practice Address - Phone:614-533-5500
Practice Address - Fax:614-533-5593
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01094330A2084N0400X
OH35.0911712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3123328Medicaid
OHH015832Medicare PIN