Basic Information
| Provider Information | |||||||||
| NPI: | 1962690073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NWANKWO | ||||||||
| FirstName: | UCHEBIKE | ||||||||
| MiddleName: | NNAGOZIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 STATE ST SE | ||||||||
| Address2: | STE 228 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166851808 | ||||||||
| FaxNumber: | 6166851850 | ||||||||
| Practice Location | |||||||||
| Address1: | 2373 64TH ST SW | ||||||||
| Address2: | STE 1300 | ||||||||
| City: | BYRON CENTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166851350 | ||||||||
| FaxNumber: | 6162617191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2007 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57013082 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 57013082 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics | 207RA0000X | 4301098721 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Adolescent Medicine |
No ID Information.