Basic Information
Provider Information | |||||||||
NPI: | 1003123084 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OZOR | ||||||||
FirstName: | UCHENNA | ||||||||
MiddleName: | LORETTA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | OFFIAH | ||||||||
OtherFirstName: | UCHENNA | ||||||||
OtherMiddleName: | LORETTA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 17600 DETROIT AVE | ||||||||
Address2: | APT 312 | ||||||||
City: | LAKEWOOD | ||||||||
State: | OH | ||||||||
PostalCode: | 441073443 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2169128140 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2351 E 22ND ST | ||||||||
Address2: |   | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 441153111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2168616200 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/11/2010 | ||||||||
LastUpdateDate: | 09/11/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57.017385 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.