MEDICARE: DR. ONWUKAMIKE PATRICK NWANKPA DPM

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	213E00000X	Podiatrist	016005543	IL
2	213EP0504X	Public Medicine Podiatrist	016005543	IL
3	213EP1101X	Primary Podiatric Medicine Podiatrist	016005543	IL
4	213ER0200X	Radiology Podiatrist	016005543	IL
5	213ES0103X	Foot & Ankle Surgery Podiatrist	016005543	IL

General Provider Information

NPI Number	:	1801143482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ONWUKAMIKE PATRICK NWANKPA DPM

Provider Business Mailing Address
First Line	:	1429 PITNER AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3935
Country	:	US
Telephone Number	:	773-407-5988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1429 PITNER AVE
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-3935
Country	:	US
Telephone Number	:	773-407-5988
Fax Number	:

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

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	11/06/2013

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