MEDICARE: CHIKWENDU C NWOSU MD

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	207R00000X	Internal Medicine Physician	2006022624	MO
2	208M00000X	Hospitalist Physician	37888	AZ
3	208100000X	Physical Medicine & Rehabilitation Physician	37888	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00376722	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	767486	OTHER	HEALTHLINK
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	216979	OTHER	BCBS

General Provider Information

NPI Number	:	1104994375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIKWENDU C NWOSU MD

Provider Business Mailing Address
First Line	:	3846 E LAFAYETTE AVE
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-9130
Country	:	US
Telephone Number	:	917-474-0025
Fax Number	:

Provider Business Practice Location Address
First Line	:	2919 S ELLSWORTH RD
Second Line	:	SUITE 139
City	:	MESA
State	:	AZ
Zip	:	85212-2164
Country	:	US
Telephone Number	:	917-474-0025
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	08/06/2014

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Directions to “ CHIKWENDU C NWOSU MD” Practice Location

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