Individual
DR. ITEGBEMIE OBAITAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., M.P.H
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01081914A
IN
207RG0100X
Gastroenterology Physician
Primary
01081914A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264910411
MEDICARE PTAN
IN
05
—
300025536
—
IN
Enumeration date
04/19/2016
Last updated
03/20/2025
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