MEDICARE: UZOMA C OSUCHUKWU M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	16137	NV

General Provider Information

NPI Number	:	1063760411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UZOMA C OSUCHUKWU M.D

Provider Business Mailing Address
First Line	:	4310 W CHEYENNE AVE STE 100
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:	617-515-2570
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 W CHEYENNE AVE STE 100
Second Line	:
City	:	N LAS VEGAS
State	:	NV
Zip	:	89032-2484
Country	:	US
Telephone Number	:	617-515-2570
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2012
Last Update Date	:	04/27/2020

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