Provider Demographics
NPI:1992770440
Name:OZOIGBO, IKECHUKWU DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:IKECHUKWU
Middle Name:DANIEL
Last Name:OZOIGBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:765-472-5335
Mailing Address - Fax:260-479-2921
Practice Address - Street 1:285 W 12TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1654
Practice Address - Country:US
Practice Address - Phone:765-472-5335
Practice Address - Fax:260-479-2921
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200258490AMedicaid
IN200258490AMedicaid
IN200258490AMedicaid
INM400021110Medicare PIN