Provider Demographics
NPI:1144496191
Name:ODIBO, MICHAEL CHUKWUMA (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHUKWUMA
Last Name:ODIBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1215 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7306
Mailing Address - Country:US
Mailing Address - Phone:910-228-5894
Mailing Address - Fax:910-228-5897
Practice Address - Street 1:1215 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7306
Practice Address - Country:US
Practice Address - Phone:910-228-5894
Practice Address - Fax:888-836-5759
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08470600207R00000X
MI4301091533207R00000X
KY42141208M00000X
NY251015208M00000X
NC2015-01360207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100061340Medicaid
KY000000592390OtherANTHEM BCBS
KY000000592390OtherANTHEM
KY000000592390OtherANTHEM
KY00280094Medicare PIN