MEDICARE: ARTHUR EBERE NWAUBANI 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	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	ME106875	FL
2	2084N0600X	Clinical Neurophysiology Physician	ME106875	FL

General Provider Information

NPI Number	:	1679748107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTHUR EBERE NWAUBANI MD

Provider Business Mailing Address
First Line	:	PO BOX 490950
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34749-0950
Country	:	US
Telephone Number	:	352-431-3600
Fax Number	:	352-460-0853

Provider Business Practice Location Address
First Line	:	312 S LAKE ST
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-5920
Country	:	US
Telephone Number	:	352-431-3600
Fax Number	:	352-460-0853

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

Provider Enumeration Date	:	04/25/2008
Last Update Date	:	08/01/2013

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