Provider Demographics
NPI:1679637565
Name:OZOR, MARTIN CHIDUBEM (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:CHIDUBEM
Last Name:OZOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:720 W HILL ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2216
Practice Address - Country:US
Practice Address - Phone:502-636-3164
Practice Address - Fax:502-634-3731
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40367207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000556617OtherANTHEM - NLPCC
084017OtherSIHO - NICC
KYP00434871OtherRRMCR - NICC
KYP00752035OtherRAILROAD MEDICARE - NLPCC
IN200938410OtherANTHEM INDIANA MEDICAID- NORTON ICC
KY200938410OtherHEALTHY INDIANA PLAN- NORTON ICC
3316424000OtherPAD - NLPCC
KY7100025530Medicaid
091199OtherSIHO - NLPCC
000000507019OtherANTHEM - NICC
KY196290FFFFOtherMEDICARE IN NICC
50015237OtherPASSPORT - NLPCC
000000507019OtherANTHEM - NICC
091199OtherSIHO - NLPCC
KY0042306Medicare PIN