MEDICARE: CHERECHI C OGWO 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	53913	TN
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	53913	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720321060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERECHI C OGWO MD

Provider Business Mailing Address
First Line	:	875 W POPLAR AVE STE 23
Second Line	:
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-2598
Country	:	US
Telephone Number	:	901-744-3362
Fax Number	:	901-844-1439

Provider Business Practice Location Address
First Line	:	6263 POPLAR AVE
Second Line	:	STE 1052
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4736
Country	:	US
Telephone Number	:	901-448-5814
Fax Number	:

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

Provider Enumeration Date	:	04/05/2013
Last Update Date	:	11/22/2021

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