Individual
IKENNA E OBASI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1811 WEIR DR STE 270, WOODBURY, MN 55125-6741
(651) 714-9646
(651) 714-9647
Mailing address
1100 LAKE VIEW DR, WAUSAU, WI 54403-6785
(715) 848-4454
(715) 845-5398
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
56761
WI
2084P0800X
Psychiatry Physician
Primary
63230
MN
390200000X
Student in an Organized Health Care Education/Training Program
56761
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56761
WI STATE LIC
WI
Enumeration date
05/01/2012
Last updated
11/19/2018
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