Provider Demographics
NPI:1568921864
Name:OSEHOBO, EHIZELE MAJIRI (MD)
Entity type:Individual
Prefix:DR
First Name:EHIZELE
Middle Name:MAJIRI
Last Name:OSEHOBO
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-208-2212
Mailing Address - Fax:239-935-5067
Practice Address - Street 1:11215 METRO PKWY STE 1
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33966-1206
Practice Address - Country:US
Practice Address - Phone:239-208-2212
Practice Address - Fax:239-935-5067
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-16
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN701772084N0400X, 2084V0102X
MO20240073352084N0400X
390200000X
FLME1655612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120822900Medicaid
MS33296OtherMS STATE BOARD OF MEDICAL LICENSURE
TN70177OtherTN BOARD OF MEDICAL EXAMINERS