Eniola Raheem Ibirogba, M.B.B.S.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

4351047274 Issued in MI

Practice address

330 Barclay Ave NE Ste 304
Grand Rapids, MI 49503-2527

Phone

(616) 391-2160

Fax

(616) 391-2683

NPI assigned

Apr 11, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652659200000",
    "number": "1992324784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "330 BARCLAY AVE NE STE 304",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032527",
            "telephone_number": "616-391-2160",
            "fax_number": "616-391-2683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BARCLAY AVE NE STE 304",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032527",
            "telephone_number": "616-391-2160",
            "fax_number": "616-391-2683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBIROGBA",
        "first_name": "ENIOLA",
        "middle_name": "RAHEEM",
        "credential": "M.B.B.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-11",
        "last_updated": "2022-05-16",
        "certification_date": "2022-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4351047274",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Kathleen Iakiri, N.P.
• Katherine Iandoli, OTR
• Karina Ibarra Gomez
• Marina Rocio Ibarra Lavigne, PA
• Victor Ibarra
• Gena Ibrahim, MD
• Yahya Amer Ibrahim, MD
• Melonie Sue Ice, M.D.
• Jacob Iceberg, DO
• Quinn Alyse Icke

• Obstetrics & Gynecology Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Obstetrics & Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.