Provider Demographics
NPI:1578132981
Name:OGBUE, OLISAEMEKA DILIBE (MBBS)
Entity type:Individual
Prefix:
First Name:OLISAEMEKA
Middle Name:DILIBE
Last Name:OGBUE
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:OLISA
Other - Middle Name:
Other - Last Name:OGBUE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2024-10-21
Deactivation Date:2022-12-07
Deactivation Code:
Reactivation Date:2022-12-19
Provider Licenses
StateLicense IDTaxonomies
MN76340207RH0003X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology