1689940165 NPI number — DR. ANTHONY SUNDAY OTEKEIWEBIA M.D

Table of content: DR. ANTHONY SUNDAY OTEKEIWEBIA M.D (NPI 1689940165)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689940165 NPI number — DR. ANTHONY SUNDAY OTEKEIWEBIA M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OTEKEIWEBIA
Provider First Name:
ANTHONY
Provider Middle Name:
SUNDAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689940165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 S LIMESTONE RM L543
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF KENTUCKY
Provider Second Line Business Practice Location Address:
800 ROSE STREET
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-2987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-552-3393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  47973 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 025135000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".